目的 分析儿科重症监护室收治的重症溺水患儿的临床特征，并探究其死亡的危险因素。 方法 回顾性分析2015年1月—2024年12月收治的49例重症溺水患儿的临床资料。采用多因素logistic回归分析筛选重症溺水患儿死亡的危险因素并构建预测模型，利用受试者操作特征曲线评估构建的模型预测死亡风险的效能。 结果 49例患儿中，病死率为24%（12/49），存活者神经系统后遗症发生率为22%（8/37）。多因素logistic回归分析显示，入院格拉斯哥昏迷评分（Glasgow Coma Scale, GCS）（OR=0.43，P<0.05）、溺水时间（OR=1.22，P<0.05）及院前总时间（每延长10 min，OR=1.85，P<0.05）是重症溺水患儿死亡的危险因素。由上述3个因素构建重症溺水患儿死亡预测模型logit（P）=6.26-0.85×入院GCS评分（分）+0.20×溺水时间（min）+0.62×［院前总时间（min）/10］，该模型的受试者操作特征曲线下面积为0.912（P<0.001），灵敏度为83.3%，特异度为91.9%。 结论 儿童重症溺水具有较高的病死率和不良结局发生率。入院GCS评分、溺水时间和院前总时间是预测死亡的核心危险因素，三者联合可作为早期风险分层的有效指标。
Objective To study the clinical characteristics of children with severe drowning admitted to the pediatric intensive care unit and to identify risk factors for mortality. Methods Clinical data of 49 children with severe drowning admitted between January 2015 and December 2024 were retrospectively analyzed. Multivariable logistic regression was used to determine risk factors for mortality and to construct a prediction model. Model performance for mortality risk was evaluated using the receiver operating characteristic (ROC) curve. Results Among the 49 patients, the mortality rate was 24% (12/49), and the incidence of neurological sequelae among survivors was 22% (8/37). Multivariable logistic regression analysis showed that admission Glasgow Coma Scale (GCS) score (OR=0.43, P<0.05), drowning duration (OR=1.22, P<0.05), and total prehospital time (per 10 minutes increase, OR=1.85, P<0.05) were associated with mortality. A mortality prediction model was constructed based on these three factors: logit(P)=6.26-0.85×GCS score at admission + 0.20×drowning duration (minutes) + 0.62×[total prehospital time (minutes)/10]. The area under the ROC curve was 0.912 (P<0.001), with a sensitivity of 83.3% and a specificity of 91.9%. Conclusions Severe drowning in children has a high mortality and a high rate of adverse outcomes. Admission GCS score, drowning duration, and total prehospital time are core risk factors for predicting mortality, and their combination serves as an effective indicator for early risk stratification.
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