目的 比较Silverman-Anderson评分和Downes评分这两种评分法对足月新生儿呼吸衰竭的预测价值。 方法 采用便利抽样法，选取2020年7月至2021年7月在新生儿重症监护病房住院治疗的患有肺部疾病的足月新生儿为研究对象。根据新生儿呼吸衰竭诊断标准将其分为呼吸衰竭组（65例）和非呼吸衰竭组（363例），采用Silverman-Anderson评分法和Downes评分法对其进行评估，采用受试者工作特征（receiver operating characteristic，ROC）分析法比较两种无创评分法对足月新生儿呼吸衰竭的预测价值。 结果 428例足月新生儿中，共有65例出现呼吸衰竭（15.2%）。Silverman-Anderson评分评估耗费时间为（90±8）s，低于Downes评分［（150±13）s］（P<0.001）。呼吸衰竭组上述两种无创评分法的评分均高于非呼吸衰竭组（P<0.001）。Silverman-Anderson评分法预测呼吸衰竭的ROC曲线下面积为0.876，最佳临界值为4.50分时，灵敏度、特异度、约登指数分别为0.908、0.694、0.602；Downes评分法预测呼吸衰竭的ROC曲线下面积为0.918，最佳临界值为6.00分时，灵敏度、特异度、约登指数分别为0.723、0.953、0.676；Downes评分法的ROC曲线下面积大于Silverman-Anderson评分法（P=0.026）。 结论 Silverman-Anderson评分法和Downes评分法均能有效预测足月新生儿呼吸衰竭风险，其中Silverman-Anderson评分法评估耗费时间更短，但Downes评分法预测效能更高。建议在一般性评估中可采用预测效能更高的Downes评分法，而在紧急情况评估中可使用更加快速的Silverman-Anderson评分法。
Abstract
Objective To study the value of Silverman-Anderson score versus Downes score in predicting respiratory failure in full-term neonates. Methods The convenience sampling method was used to select the full-term neonates with lung diseases who were hospitalized in the neonatal intensive care unit from July 2020 to July 2021. According to the diagnostic criteria for neonatal respiratory failure, they were divided into a respiratory failure group (65 neonates) and a non-respiratory failure group (363 neonates). Silverman-Anderson score and Downes score were used for evaluation. The receiver operating characteristic analysis was used to compare the value of the two noninvasive scores in predicting respiratory failure in full-term neonates. Results Among the 428 full-term neonates, 65 (15.2%) had respiratory failure. The Silverman-Anderson score had a significantly shorter average time spent on evaluation than the Downes score [(90±8) seconds vs (150±13) seconds; P<0.001]. The respiratory failure group had significantly higher points in both the Silverman-Anderson and Downes scores than the non-respiratory failure group (P<0.001). The Silverman-Anderson score had an AUC of 0.876 for predicting respiratory failure, with a sensitivity of 0.908, a specificity of 0.694, and a Youden index of 0.602 at the optimal cut-off value of 4.50 points. The Downes score had an AUC of 0.918 for predicting respiratory failure, with a sensitivity of 0.723, a specificity of 0.953, and a Youden index of 0.676 at the optimal cut-off value of 6.00 points. The Downes score had significantly higher AUC for predicting respiratory failure than the Silverman-Anderson score (P=0.026). Conclusions Both Silverman-Anderson and Downes scores can predict the risk of respiratory failure in full-term neonates. The Silverman-Anderson score requires a shorter time for evaluation, while the Downes score has higher prediction efficiency. It is recommended to use Downes score with higher prediction efficiency in general evaluation, and the Silverman-Anderson score requiring a shorter time for evaluation can be used in emergency.
关键词
呼吸衰竭 /
Silverman-Anderson评分 /
Downes评分 /
预测 /
新生儿
Key words
Respiratory failure /
Silverman-Anderson score /
Downes score /
Prediction /
Neonate
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 Lillie J, Boot L, Speggiorin S, et al. Factors behind decline of venovenous extracorporeal membrane oxygenation to support neonatal respiratory failure[J]. Pediatr Crit Care Med, 2020, 21(8): e502-e504. PMID: 32195900. DOI: 10.1097/PCC.0000000000002340.
2 Zhang L, Qiu Y, Yi B, et al. Mortality of neonatal respiratory failure from Chinese northwest NICU network[J]. J Matern Fetal Neonatal Med, 2017, 30(17): 2105-2111. PMID: 27651118. DOI: 10.1080/14767058.2016.1238894.
3 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 4版. 北京: 人民卫生出版社, 2011: 423-425.
4 Silverman WA, Andersen DH. A controlled clinical trial of effects of water mist on obstructive respiratory signs, death rate and necropsy findings among premature infants[J]. Pediatrics, 1956, 17(1): 1-10. PMID: 13353856.
5 Downes JJ, Vidyasagar D, Boggs TR, et al. Respiratory distress syndrome of newborn infants. I. New clinical scoring system (RDS score) with acid-base and blood-gas correlations[J]. Clin Pediatr (Phila), 1970, 9(6): 325-331. PMID: 5419441. DOI: 10.1177/000992287000900607.
6 郭浩伟, 胡金绘, 朱红利, 等. Silverman Anderson评分预测早产儿呼吸衰竭的诊断界值[J]. 中华诊断学电子杂志, 2014, 2(1): 49-51. DOI: 10.3877/cma.j.issn.2095-655X.2014.01.009.
7 胡金绘, 查丽, 高子波, 等. Downes评分对足月新生儿呼吸衰竭的预测价值[J]. 中华围产医学杂志, 2015, 18(10): 774-777. DOI: 10.3760/cma.j.issn.1007-9408.2015.10.012.
8 Murki S, Singh J, Khant C, et al. High-flow nasal cannula versus nasal continuous positive airway pressure for primary respiratory support in preterm infants with respiratory distress: a randomized controlled trial[J]. Neonatology, 2018, 113(3): 235-241. PMID: 29393237. DOI: 10.1159/000484400.
9 Macooie AA, Fakour Z, Roanaghi P. Comparative evaluation of the effects of BLES and Survanta on treatment of respiratory distress syndrome in newborns[J]. J Family Med Prim Care, 2018, 7(5): 1063-1067. PMID: 30598958. PMCID: PMC6259541. DOI: 10.4103/jfmpc.jfmpc_188_17.
10 Bandos AI, Guo B, Gur D. Estimating the area under ROC curve when the fitted binormal curves demonstrate improper shape[J]. Acad Radiol, 2017, 24(2): 209-219. PMID: 27884464. PMCID: PMC5237396. DOI: 10.1016/j.acra.2016.09.020.
11 Tang LL, Zhang W, Li Q, et al. Least squares regression methods for clustered ROC data with discrete covariates[J]. Biom J, 2016, 58(4): 747-765. PMID: 26848938. PMCID: PMC5178105. DOI: 10.1002/bimj.201500099.
12 王卫平, 孙锟, 常立文. 儿科学[M]. 9版. 北京: 人民卫生出版社, 2018: 444-446.
PDF(544 KB)
