2008-2012年苏州地区重症社区获得性肺炎死亡危险因素分析

目的：了解苏州地区重症社区获得性肺炎（community acquired pneumonia,CAP）死亡危险因素.方法：将2008年1月1日-2012年12月30日收住儿科重症监护病房（pediatric intensive care unit,PICU）的803例重症CAP患儿的流行病学、临床和实验室以及预后资料分析比较.结果：本研究803例重症CAP患儿中82.1%在1岁以下,31.4%（252/803）存在基础疾病,死亡率为7.5%,呼吸道病原检出最多为呼吸道合胞病毒（respiratory syncytial virus,RSV）46.6%（189/406）,其次为支原体19.7%（80/406）,细菌中最多的是肺炎链球菌、流感嗜血杆菌和卡他莫拉菌,分别占12.3%（50/406）、7.9%（32/406）和3.0%（12/406）,单因素分析时,死亡危险因素为患儿出现意识改变、呼吸频率＞70次/min、呻吟、点头样呼吸、青紫、入院时动脉血氧饱和度（arterial oxygen saturation,SaO2）＜80%和血红蛋白（hemoglobin,Hb）＜8 g/dL,而通过多因素Logistic回归分析显示其死亡危险因素为患儿存在先天性心脏病、21三体综合征、脑性瘫痪和免疫缺陷.结论：年龄和基础疾病状态与重症CAP的死亡率密切相关,基础疾病状态和危重症状态的早期识别和干预对死亡率的改善可能有意义,根据当地CAP病原学谱的特点制定合适的预防接种计划可能会减少重症CAP的发生.

Determination of risk factors for mortality in children with severe community acquired pneumonia in Suzhou from 2008 to 2012

Objective： To determine the risk factors of mortality for severe community acquired pneumonia（CAP） in children in Suzhou. Methods： Data of epidemiological and clinical features, laboratory findings and outcomes from 803 children with severe CAP between Jan. 1^st 2008 to Dec. 30^th 2012 in pediatrics intensive care unit（PICU） were analysed. Results： Eighty-two percent of 803 children with severe CAP were less than 1 year old; 31.4%（252/803） of them had co-morbid conditions. The mortality of severe CAP in PICU was 7.5%; respiratory syncytial virus（RSV） was the most common pathogen, which was detected positive in 46.6%（189/406） of children, followed by mycoplasma, 19.7%（80/406）; the most common bacterial pathogen were Strptococcus pneumoniae 12.3%（50/406）, Haemophilus influenza b 7.9%（32/406） and Moraxella catarrhalis 3.0%（12/406）. In univariate analysis, PICU admission respiratory rate 〉70/min, grunting/groaning, head nodding, cyanosis, SAO2〈80% when admitted and anemia were associated with respiratory failure and mortality. In multivariate analysis, presence of congenital heart disease, Trisomy 21, cerebral palsy and immunodeficiency correlated with mortality. Conclusions： Young age and underlying disease are associated factors of severe CAP in Suzhou. Early evaluation and management of co-morbid conditions and severity of CAP is beneficial to reduce the mortality of severe CAP, appropriate vaccination program should be established according to the local pathogen spectrum.