探讨Silverman Anderson(SA)评分预测早产儿呼吸衰竭的诊断界值。

选取2013年1—12月入住淮安市妇幼保健院新生儿医学中心的胎龄小于37周、吸入空气下、脉搏氧饱和度小于85.0%、需要氧疗的新生儿160例，分别在入院时进行SA评分，同时抽取桡动脉血进行血气分析，通过综合分析确定早产儿呼吸衰竭诊断。采用受试者工作特征(ROC)曲线，确定SA预测新生儿呼吸衰竭的诊断界值。

160例患儿中，有102例被诊断为呼吸衰竭，发生率为63.8%，SA评分为(5.24±1.22)分；ROC曲线下面积为0.91，面积标准误为0.023，面积95%的可信区间为(0.866，0.955)；SA值用于诊断新生儿呼吸衰竭有重要意义(P＝0.000)，SA值越高诊断呼吸衰竭的可能性越大。在假阴性率和假阳性率的危害性同等意义时，SA最佳诊断界值为5.5，敏感度为67.6%，假阳性率为3.4%，假阴性率为37.1%。当以敏感度和假阴性率为主时，选择SA＝4.5为诊断界值，其敏感度为93.1%，假阳性率为31.0%，假阴性率为14.9%。

SA评分能早期预测早产儿呼吸衰竭，有利于临床医师在床边快速评估呼吸衰竭早产儿的呼吸窘迫程度和病情的严重程度，及时采取正确的处理措施，提高早产儿呼吸衰竭的救治质量。

To explore the diagnostic cutoff value of the Silverman Anderson score(SA) predict to preterm infant with respiratory failure(RF).

From January 2013 to December 2013, 160 cases of the preterm infants with RF who needed for oxygen therapy were randomly selected from the Huaian Maternity and Child Healthcare Hospital.SA scores of all preterm infants at admission were respectively recorded, while extracting radial arterial for blood gas analysis. The diagnosis of RF were determined by comprehensive analysis. The diagnostic cutoff of the SA predicting preterm RF were confirmed by receiver operating characteristic (ROC) curve.

RF rate was 63.8%.SA score was 5.24±1.22. The area under the ROC curve was 0.91, area of the standard error was 0.023. 95% confidence interval area was 0.866-0.955.There was statistically significance in SA value for the diagnosis of preterm RF(P=0.000). The higher value of SA was, the greater the likelihood of preterm RF was. When the dangers of missed diagnosis rate is equal to that of misdiagnosis rate, the optimal SA diagnostic cutoff value was 5.5, the sensitivity was 67.6%, misdiagnosis rate was 3.4% and missed diagnosis rate was 37.1%.When sensitivity and misdiagnosis were rate dominant, the optimal SA diagnostic cutoff value was 4.5, the sensitivity was 93.1%, misdiagnosis rate was 31.0% and missed diagnosis rate was 14.9%.

The SA score can early predict preterm RF. It might help the clinicians to rapidly assess the severity extent of preterm infants with RF and give appropriate measures to the preterm infants at the bedside.Therefore, it might improve the quality of treatment of the preterm infants with RF.