探讨入院时转运生理稳定指数(TRIPS)在早产儿病情危重度及其预后评估中的价值。

选择2014年7月至2016年12月，于南京医科大学附属无锡妇幼保健院新生儿重症监护病房(NICU)住院治疗的130例胎龄<32周早产儿为研究对象。对其同时进行TRIPS评分和新生儿危重病例评分(NCIS)。采用Peason相关性分析，分析2种评分法的相关性，再以NCIS判定的早产儿病情危重度为标准，绘制TRIPS评分评估早产儿病情危重度的受试者工作特征(ROC)曲线，以获取TRIPS评分判定早产儿病情危重度的最佳临界值，并据此将早产儿分为非危重组(TRIPS评分<最佳临界值)和危重组(TRIPS评分>最佳临界值)2组。采用成组t检验、Wilcoxon秩和检验及χ²检验，对2组早产儿早产相关并发症及临床转归等计量及计数资料进行统计学比较。本研究遵循的研究程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

① Pearson相关性分析结果显示，TRIPS评分与NCIS呈线性负相关关系(r＝－0.421，P<0.001)。②TRIPS评分评估早产儿病情危重度的ROC曲线显示，TRIPS评分判定早产儿病情危重度的最佳临界值为13.5分，其曲线下面积(AUC)为0.721 (95%CI：0.634～0.807),敏感度为86.5%，特异度为52.6%。③根据TRIPS评分最佳临界值的分组结果，非危重组早产儿为76例，危重组为54例。④危重组早产儿支气管肺发育不良(BPD)及颅内出血发生率(37.0%、40.7%)，均显著高于非危重组(15.8%、15.8%)，其转出NICU时体重及好转出院率[(2 025±533) g，72.2%]，均显著低于非危重组[(2 192±267) g，96.1%]，并且差异均有统计学意义(χ²＝7.681，P＝0.006；χ²＝10.176，P＝0.001；t＝－2.351，P＝0.020；χ²＝15.441，P<0.001)。2组早产儿坏死性小肠结肠炎、院内感染及早产儿视网膜病变(ROP)发生率，以及住院时间比较，差异均无统计学意义(P>0.05)。

早产儿入院时进行TRIPS评分，可用于早产儿病情危重度评估及预后判断。

To investigate the values of transport risk index of physiologic stability (TRIPS) at admission to evaluate illness severity and prognosis of preterm infants.

From July 2014 to December 2016, a total of 130 preterm infants with gestational age < 32 weeks who were hospitalized in the neonatal intensive care unit (NICU) of Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University were selected as research subjects. All preterm infants included in the study were given TRIPS score and neonatal critical illness score (NCIS) at the same time. Pearson correlation analysis was used to analyze the correlation between TRIPS score and NCIS, then the results of NCIS were taken as standard, the receiver operating characteristic (ROC) curve which assessed the severity of preterm infants with TRIPS score was drawn, to get the best cutoff value of TRIPS score in judging the severity of preterm infants. According to this best cutoff value, preterm infants of this study were divided into two groups: the non-critical group (TRIPS score < the best cutoff value) and the critical group (TRIPS score > the best cutoff value). The independent-samples t test, Wilcoxon rank sum test and chi-square test were used to compare the measurement and numeration data of premature birth related complications and clinical outcomes between two groups of preterm infants. This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

①Pearson correlation analytic results showed that there was a linear negative correlation between TRIPS score and NCIS (r=-0.421, P<0.001). ②The ROC curve of evaluation of the severity of preterm infants by TRIPS score showed that the best cutoff value for judging the severity of preterm infants by TRIPS score was 13.5 scores, the area under curve (AUC) was 0.721(95%CI: 0.634-0.807), the sensitivity was 86.5%, and the specificity was 52.6%. ③Grouping results according to the best cutoff value of TRIPS score were 76 preterm infants in non-critical group and 54 cases in critical group. ④The incidence rate of bronchopulmonary dysplasia (BPD) and intracranial hemorrhage of preterm infants in critical group (37.0%, 40.7%) were all higher than those in non-critical group (15.8%, 15.8%), also the body weight at discharge from NICU and hospital discharge rate based on improved patients′ condition in critical group [(2 025±533) g, 72.2%] were all lower than those in non-critical group [(2 192±267) g, 96.1%], and all the differences were statistically significant (χ²=7.681, P=0.006; χ²=10.176, P=0.001; t=-2.351, P=0.020; χ²=15.441, P<0.001). There were no significant differences between two groups of preterm infants in incidence rate of necrotizing enterocolitis, hospital onset of infection, retinopathy of prematurity (ROP) and duration of hospitalization (P>0.05).

TRIPS score at admission could be used to evaluate illness severity and prognosis of preterm infants.