有创机械通气重症肺炎患儿的临床特征及死亡危险因素分析

目的 探讨有创机械通气重症肺炎患儿的临床特征及死亡患儿的危险因素.方法 采用回顾性研究,收集2011年1月至2014年12月因需有创机械通气入住天津市儿童医院PICU的重症肺炎患儿资料,分析其年龄分布、病原学特点、机械通气情况、并发症及基础疾病情况,对死亡相关因素进行单因素分析及多因素分析.结果 共214例患儿符合标准纳入研究,其中男134例,女80例,总病死率6.17%.病原学检出率16.36%.死亡组患儿中位年龄大于生存组(4个月比2个月,P=0.039),年龄超过1岁患儿所占比例更高(21.43%比15.8%,P<0.001).脑病和电解质紊乱是有创机械通气重症肺炎患儿常见并发症,构成比分别为11.68%和8.41%.贫血、心脏病、呼吸系统发育异常位列基础疾病前3位(29.91%、14.49%、9.35%).Logistic多元回归分析显示,患儿发病年龄大于1岁(OR值1.019,95%CI 1.003~1.030,P=0.019),合并急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)(OR值7.254,95%CI 1.581~33.277,P=0.011),患有心脏病(OR值0.47,95%CI 0.273~0.810,P=0.007)是有创机械通气重症肺炎患儿死亡的危险因素. 结论 在救治需有创通气重症肺炎患儿时,对于年龄大于1岁、合并ARDS或患有心脏病的患儿要加强监护,积极治疗原发病,防治ARDS,必要时可行心脏手术以改善预后,降低需有创通气重症肺炎患儿的病死率.

A retrospective analysis of clinical features and risk factors of death in children with severe pneumonia treated with invasive mechanical ventilation

Objective To discuss the clinical features and risk factors of death in children with severe pneumonia treated with invasive mechanical ventilation.Methods Through a retrospective analysis of children with severe pneumonia treated with invasive mechanical ventilation,who were hospitalized in PICU of Tianjin Children′s Hospital from Jan 2011 to Dec 2014,we analyzed the distribution of age,etiologic characteristics,mechanical ventilation,complications and background diseases.The single factor analysis and multiple factors Logistic regression analysis were performed to evaluate the risk factors of death.Results A total of 214 pediatric patients were included,134 were male,and 80 were female.The case fatality rate was 6.17%,the relevance ratio of pathogenic microorganism was 16.36%.The median age of death group was older than that of the survival group(4 mouths vs 2 mouths,P=0.039).The pediatric patients who were more than 1 year old in death group were more than the survival group(21.43% vs 15.8%,P<0.001).The common complications included dencephalopathy(11.68%) and electrolyte imbalance(8.41%).Anemia,cardiopathy and alloplasia of respiratory system were the top background diseases.The results of Logistic multivariate regression analysis showed that there were significant differences in the age above 1 year old(OR:1.019,95%CI:1.003-1.030,P=0.019),secondary acute respiratory distress syndrome(OR:7.254,95%CI:1.581-33.277,P=0.011) and accompanying cardiopathy(OR:0.47,95%CI:0.273-0.81,P=0.007).Conclusion The risk factors of death in children with severe pneumonia treated with invasive mechanical ventilation are the following:the age above 1 year old,secondary acute respiratory distress syndrome or accompanying cardiopathy.