早期使用糖皮质激素对重症肺炎合并呼吸衰竭患儿预后影响初探

目的：初步探讨早期使用糖皮质激素对重症肺炎合并呼吸衰竭患儿预后的影响。方法回顾性收集2011年1月至2014年12月天津市儿童医院PICU收治的因重症肺炎合并呼吸衰竭患儿的资料，以发病3d内是否全身使用糖皮质激素治疗为标准将患儿分为激素治疗组和非激素治疗组，以存活和死亡为终点统计两组患儿预后。对于存活患儿根据其出院时情况将预后进一步分为好转及合并感染后闭塞性细支气管炎两种情况。采用卡方检验，比较分析早期糖皮质激素治疗对重症肺炎合并呼吸衰竭患儿预后的影响。结果共216例患儿符合标准纳入研究，其中激素治疗组68例，非激素治疗组148例。两组患儿入院时年龄、性别、危重病例评分及合并症等情况无差异。激素治疗组患儿死亡15例（22.0％），虽略低于非激素治疗组41例（27.7％），但两组间差异无统计学意义（χ2＝0.773，P＞0.05）。在160例存活患儿中，激素治疗组患儿感染后闭塞性细支气管炎的发生率较非激素治疗组增高28.3％（15／53例）vs.2.8％（3／107例），差异有统计学意义（χ2＝23.080，P＜0.005）。结论早期糖皮质激素治疗不能降低重症肺炎呼吸衰竭患儿的病死率，但可能增加存活患儿发生感染后闭塞性细支气管炎的风险，因此在重症肺炎的早期治疗中应慎用糖皮质激素。

The effect of early use of glucocorticoids on the prognosis of pediatric patients with severe pneumonia complicaet d with respiratory failure

Objective To preliminarily discuss about the effect of early use of glucocorticoids on the prognosis of pedai tric patients with respiratoryf ailure by severe pneumonia.Metho ds The patients enrolled in our study were treated for respiratory failure by severe pen umonia in PICU of Tianjin Children′s Hospitla from January 2011 to December 2014.These patients were divided into two groups:glucocorticoid treatment group and non-glucocorticoid treatment group.The patients in the glucocorticoid treatment group were treated with glucocro ticoid in 3 days of onset.Based on this main division, retrospective analyses weer performed wiht regard to the prognosis:survival or death.Survival ap tients wo uld be furteh r divided into uc re group and post-infectiou s bronchiolitis obil terans group.We aan lyzed the data wi thχ2 -et st about th e effect of early use of glucocotr icoids on the prognosis of pediatric patients withr espiratory failure by seveer pneumonia.Results Two hundred and sixteen patientsw ere divied d into glucoc orticoid treatment group ( n =68 ) and non-gul cocotr icoid treatment group(n=148).Significant difef rence was not found in aeg ,gened r,pediatir c critical illen ss score and complications betw een the glucocorticoid treatment group and non-glucocorticoid treatment group.Although the mortality rate of glucocorticoid treatment group(22.06%) was slightly lower than that of non-glucocorticoid treatment group(27.70%) ,there was no statistical difference between the two groups (χ2 =0.773,P >0.05).For the 160 survival patients,the occurrence ar te of post-inef ctious brno chiolitis obil terans in the glucocotr icoid treatment group ni crae sed compra ed with that in the non-glucocorticoid treat-ment group28.3%(15/53) vs.2.8%(3/107); χ2 =23.080,P<0.005].C onclusion The early use of glucocorticoids cannot reduce the mortality of the pediatric patients with respiratory failure by severe pneumo-nia,but it can increase the risk of post-infectious bronchiolitis obliterans for survival patients.Therefore, glucocorticoids should be used with caution in the early treatment of severe pneumonia.