心脏手术后心肺功能不全婴幼儿及儿童临床评分系统的前瞻性评估

Prospective evaluation of clinical scoring systems in infants and children with cardiopulmonary insufficiency after cardiac surgery.

作者信息

Zobel G, Rödl S, Rigler B, Metzler H, Dacar D, Grubbauer H M, Beitzke A

机构信息

Department of Pediatrics, University of Graz, Austria.

出版信息

J Cardiovasc Surg (Torino). 1993 Aug;34(4):333-7.

PMID:8227115

Abstract

OBJECTIVE

To document severity of illness and to evaluate the predictive value of clinical scoring systems in infants and children with cardiopulmonary insufficiency after cardiac surgery.

DESIGN

Prospective study with follow up to hospital discharge.

SETTING

A multidisciplinary pediatric ICU in a University Hospital.

PATIENTS

Between 1/1989 and 4/1992 441 infants and children with congenital heart disease underwent open heart surgery. 128 of these patients developed postoperative cardiopulmonary insufficiency and were entered into this study.

METHODS

Data relevant to the Acute Physiologic Score for Children (APSC), Pediatric Risk of Mortality (PRISM), Therapeutic Intervention Scoring System (TISS) and Organ System Failure (OSF) score were collected in all patients during the first 4 days of postoperative intensive care.

RESULTS

The mean age of the patients was 1.5 +/- 0.2 years. The mean duration of mechanical ventilation and ICU care was 6.2 +/- 0.6 and 8.1 +/- 0.7 days, respectively. On the first postoperative day the mean APSC and PRISM scores of survivors and nonsurvivors were 13.9 +/- 1.3 vs 24.5 +/- 1.3 (p < 0.001) and 6.1 +/- 0.5 vs 19.6 +/- 1.9 (p < 0.001), respectively. The mean TISS and OSF scores of survivors and nonsurvivors were 46 +/- 0.8 vs 57.8 +/- 1.4 (p < 0.001), and 2.2 +/- 0.2 vs 3.4 +/- 0.2 (p < 0.001), respectively. The overall hospital mortality rate was 9.9%, the hospital mortality rate of patients with postoperative cardiopulmonary insufficiency 34%. Patients with an APSC score < 10 and a PRISM score < 5 had a survival rate of 100%, whereas patients with an APSC score > 30 and a PRISM score > 25 had a mortality rate of 100%. The area under the receiver operating characteristic (ROC) curve for APSC, PRISM and TISS was 0.847, 0.826 and 0.793, respectively.

CONCLUSION

APSC, PRISM and TISS describe accurately severity of illness in infants and children with cardiopulmonary insufficiency after cardiac surgery and all scores identify those patients at increased risk for mortality.

摘要

目的

记录心脏手术后婴幼儿和儿童心肺功能不全的疾病严重程度，并评估临床评分系统的预测价值。

设计

前瞻性研究，随访至出院。

地点

大学医院的多学科儿科重症监护病房。

患者

1989年1月至1992年4月期间，441例先天性心脏病婴幼儿和儿童接受了心脏直视手术。其中128例患者术后发生心肺功能不全并纳入本研究。

方法

在术后重症监护的前4天，收集所有患者与儿童急性生理评分（APSC）、儿科死亡风险（PRISM）、治疗干预评分系统（TISS）和器官系统衰竭（OSF）评分相关的数据。

结果

患者的平均年龄为1.5±0.2岁。机械通气和重症监护的平均持续时间分别为6.2±0.6天和8.1±0.7天。术后第1天，存活者和非存活者的平均APSC和PRISM评分分别为13.9±1.3对24.5±1.3（p<0.001）和6.1±0.5对19.6±1.9（p<0.001）。存活者和非存活者的平均TISS和OSF评分分别为46±0.8对57.8±1.4（p<0.001）和2.2±0.2对3.4±0.2（p<0.001）。总体医院死亡率为9.9%，术后心肺功能不全患者的医院死亡率为34%。APSC评分<10且PRISM评分<5的患者存活率为100%，而APSC评分>30且PRISM评分>25的患者死亡率为100%。APSC、PRISM和TISS的受试者工作特征（ROC）曲线下面积分别为0.847、0.826和0.793。