构建预测影响先天性食管闭锁预后危险因素评分系统的研究

发布时间：2018-04-27 03:34

  本文选题：先天性食管闭锁 + 病死率　； 参考：《重庆医科大学学报》2017年08期

【摘要】：目的:构建预测食管闭锁(congenital esophageal atresia,CEA)新生儿院内病死的量化评分系统。方法:比较2004年3月至2016年5月在重庆医科大学附属儿童医院收诊的198例CEA患儿相关指标,分析导致CEA预后不良的独立危险因素并量化赋值。结果:CEA病死率为18.1%(n=36)。单因素分析发现病死组早产、低出生体质量、吻合口漏、长距型CEA、呼吸衰竭、手术后败血症、呼吸窘迫综合征、气胸及休克患病率高于存活组(P0.05)。logistic回归分析发现吻合口漏(OR=10.75,95%CI=3.113~37.128)、呼吸衰竭(OR=4.104,95%CI=2.292~7.355)、手术后败血症(OR=3.564,95%CI=1.516~8.375)、低出生体质量(OR=8.379,95%CI=3.357~20.917)与高病死率有关(P0.05)。依据各危险变量赋值构建的受试者工作曲线的曲线下面积为0.902,界点分数为2,灵敏度、特异度、阳性及阴性预测值分别为0.861、0.827、0.525、0.964。低危险(0~1分)、中危险(2~4分)、高危险组(≥5分)病死率分别为3.6%、49.1%、100%,3组比较差异有统计学意义(χ2=73.198,P=0.000)。结论:吻合口漏、呼吸衰竭、手术后败血症、低出生体质量与CEA预后不良有关,在总分为8分的本系统中,得分越高预后越差。
[Abstract]:Objective: to establish a quantitative scoring system for predicting nosocomial death of esophageal atresia esophageal atresia. Methods: from March 2004 to May 2016, 198 children with CEA were enrolled in the affiliated Children's Hospital of Chongqing Medical University. The independent risk factors leading to poor prognosis of CEA were analyzed and quantified. Results the case fatality rate of 10% CEA was 18. 1%. Univariate analysis showed premature delivery, low birth weight, anastomotic leakage, long distance CEA, respiratory failure, post-operative septicemia, respiratory distress syndrome. The prevalence of pneumothorax and shock was higher than that of survival group (P 0.05. Logistic regression analysis). The results of logistic regression analysis showed that the incidence of anastomotic leakage was higher than that of survival group (P < 0.01). Logistic regression analysis showed that the incidence of anastomotic leakage was 3.1133.113 ~ 37.88%, and that of respiratory failure was 4.104 ~ 95CI2.2927.355.The incidence of septicemia after operation was 3.56495CI1.5168.375. the lower birth weight was 8.379CI3.357CI3.3577.917) and the high mortality rate (P0.055.17). The area under the curve was 0.902, the threshold score was 2, the sensitivity, specificity, positive and negative predictive values were 0.861 / 0.827 / 0.525 / 0.964, respectively. The mortality rate in the high risk group (鈮，

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