基于儿童早期预警评分的临床路径管理在高热惊厥患儿中的应用研究-现代医学

基于儿童早期预警评分的临床路径管理在高热惊厥患儿中的应用研究

单位：南通大学附属妇幼保健院儿科病区, 江苏南通 226300

分类号：R473.72

出版年·卷·期（页码）：2025·53·第三期（400-405）

摘要：

目的：探讨基于儿童早期预警评分(PEWS)建立的临床路径管理在高热惊厥(FC)患儿中的应用效果，为儿童FC临床护理提供参考。方法：采用便利抽样法收集2023年1月至2024年2月于本院急诊或儿科病房就诊的250例FC患儿为研究对象，随机分为对照组和观察组，每组各125例。对照组给予常规治疗及护理，观察组在对照组基础上给予基于PEWS的临床路径管理。记录并比较两组患儿的发病次数、退热时间、惊厥持续时间、急救转住院时间、住院时间及生命体征指标变化。结果：与对照组比，观察组患儿的发病次数、退热时间、惊厥持续时间、急救转住院时间和住院时间均显著降低，差异均有统计学意义(均P＜0.05)。护理后，观察组患儿体温、心率、呼吸频率均显著低于对照组(均P＜0.05)，且观察组护理前后各指标差值均显著大于对照组(均P＜0.05)。另外，观察组患儿并发症发生比例显著低于对照组(P＜0.05)。结论：基于PEWS建立的临床路径管理用于FC患儿可改善其临床症状，稳定其生命体征，降低患儿并发症发生率。

Objective: To investigate the application of clinical pathway management based on pediatric early warning score(PEWS) in children with febrile convulsion(FC), to provide reference for clinical nursing of FC children. Methods: The convenience sampling method was used to collect 250 cases FC children who visited the emergency or pediatric ward of our hospital from January 2023 to February 2024 as research subjects. They were randomly divided into the control group(125 cases) and the observation group(125 cases). The control group was given conventional treatment and care, while the observation group was given clinical pathway management based on PEWS in addition to the treatment and care provided by the control group. The frequency of onset, duration of fever regression, duration of convulsions, time of emergency hospitalization, hospitalization time and changes in vital signs of the two groups were recorded and compared. Results: Compared with the control group, the frequency of onset, duration of fever regression, duration of convulsions, time of emergency hospitalization, and hospitalization time of the observation group were significantly reduced, with statistically significant difference(all P＜0.05). After nursing, the body temperature, heart rate and respiratory rate in the observation group were significantly lower than those in control group(all P<0.05), and difference of each index before and after the nursing in the observation group were significantly greater than those in the control group(P<0.05). In addition, the proportion of complications in the observation group was significantly lower than that in the control group(P＜0.05). Conclusion: The clinical pathway management based on PEWS for FC children can improve clinical symptoms, stabilize the vital signs, reduce the rate of complications.

参考文献：

[1] EILBERT W,CHAN C.Febrile seizures:a review[J].J Am Coll Emerg Physicians Open,2022,3(4):e12769.
[2] 郝改领,徐丽娟,常海霞,等.NSE、GFAP、ADM在热性惊厥患儿血清中变化与神经功能损伤的关系[J].现代医学,2020,48(4):452-455.
[3] TIWARI A,MESHRAM R J,KUMAR SINGH R.Febrile seizures in children:a review[J].Cureus,2022,14(11):e31509.
[4] MONAGHAN A.Detecting and managing deterioration in children[J].Paediatr Nurs,2005,17(1):32-35.
[5] ÖZEL A,BARLAS U K,YUCE S,et al.Pediatric early warning score(PEWS) in predicting prognosis of critical pediatric trauma patients:a retrospective study[J].Braz J Anesthesiol,2024,74(5):844540.
[6] ZOHAM M H,MOHAMMADPOUR M,YAGHMAIE B,et al.Validity of pediatric early warning score in predicting unplanned pediatric intensive care unit readmission[J].J Pediatr Intensive Care,2021,12(4):312-318.
[7] QIU X,LEI Y P,ZHOU R X.SIRS,SOFA,qSOFA,and NEWS in the diagnosis of sepsis and prediction of adverse outcomes：a systematic review and Meta-analysis[J].Expert Rev Anti Infect Ther,2023,21(8):891-900.
[8] ZOU L P,LIU L Y,LI H,et al.Establishment and utility assessment of posterior reversible encephalopathy syndrome early warning scoring(PEWS) scale establishment and utility assessment of PEWS scale[J].BMC Neurol,2019,19(1):30.
[9] YE L,ZHU M,HONG F,et al.The value of pediatric early warning score combined with SBAR in neonatal pneumonia nursing:a retrospective cohort study[J].Medicine(Baltimore),2023,102(10):e33197.
[10] 中华医学会儿科学分会神经学组.热性惊厥诊断治疗与管理专家共识(2017实用版)[J].中华实用儿科临床杂志,2017,32(18):1379-1382.
[11] 庄丽丽,姚文,刘海梅,等.以反复发热和关节痛为主要表现的儿童谷固醇血症[J].东南大学学报(医学版)，2021,40(4):528-532.
[12] LEUNG J S.Febrile seizures:an updated narrative review for pediatric ambulatory care providers[J].Curr Pediatr Rev,2024,20(1):43-58.
[13] 黄玉芬,陈芷涵,黄银儿.儿童早期预警评分在急诊转运中的应用进展[J].国际儿科学杂志,2024,51(7):481-484.
[14] 蔡毓敏,张彩云,周芸,等.急诊科预检分诊中采取儿童早期预警评分系统对高热惊厥患儿抢救成功率的影响[J].中国基层医药,2024,31(8):1202-1206.
[15] 段招弟,袁娇,谢伦艳.改良儿童早期预警评分联合分级护理在急诊高热惊厥患儿中的应用[J].齐鲁护理杂志,2020,26(11):124-126.
[16] ROMAINE S T,SEFTON G,LIM E,et al.Performance of seven different paediatric early warning scores to predict critical care admission in febrile children presenting to the emergency department:a retrospective cohort study[J].BMJ Open,2021,11(5):e044091.
[17] 陈美芳,胡沈洁,凌芳,等.全程绿色通道护理路径模式对急诊高热惊厥患儿恢复情况的影响及生化指标变化[J].国际护理学杂志,2024,43(15):2812-2816.
[18] 杨梅,魏良铜,徐怡雪.早期预警评估下分级降温护理对热性惊厥患儿的康复效果[J].中国医药导报,2023,20(18):139-142,155.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录