儿童急性呼吸窘迫综合征预后及其影响因素分析

牛志民,李艳红,姜舜杰,毛向莹,李玉洁

中国当代儿科杂志 ›› 2011, Vol. 13 ›› Issue (7) : 543-546.

PDF(1137 KB)
PDF(1137 KB)
中国当代儿科杂志 ›› 2011, Vol. 13 ›› Issue (7) : 543-546.
论著·临床研究

儿童急性呼吸窘迫综合征预后及其影响因素分析

  • 牛志民,李艳红,姜舜杰,毛向莹,李玉洁
作者信息 +

Prognosis and its affecting factors in children with acute respiratory distress syndrome

  • NIU Zhi-Min, LI Yan-Hong, JIANG Shun-Jie, MAO Xiang-Ying, LI Yu-Jie
Author information +
文章历史 +

摘要

目的:了解儿童急性呼吸窘迫综合征(ARDS)的预后,探讨影响其预后的相关因素。方法:纳入78 例 ARDS 患儿,追踪确诊后 30 d 内生存状况。结果:(1)78 例 ARDS 患儿中,死亡 51 例,生存 27 例,30 d 生存率为 35%,平均生存 14.4 d,中位生存时间 8 d,确诊 ARDS 后 3 d 内为死亡的高峰期。(2)死亡患儿和生存患儿在年龄、原发病、新生儿肺透明膜病的构成比、小儿危重病例评分(PCIS)、机械通气时间、氧合指数(PaO2/FiO2)、WBC 和受累器官数目方面差异存在统计学意义(P<0.05或0.01)。Cox多因素分析显示年龄(HR 3.924~3.938)、原发病(HR=1.817)和 PCIS(HR=0.469)是发生死亡的危险因素。结论:ARDS 后 3 d 内是死亡的高危期。年龄、原发致病因素和 PCIS 是影响 ARDS 患儿预后的独立因素。

Abstract

OBJECTIVE: To study the prognosis and the factors affecting the prognosis in children with acute respiratory distress syndrome (ARDS). METHODS: Seventy-eight children with ARDS were enrolled. The states of their survival within 30 days were followed-up. RESULTS: Of the 78 children with ARDS, 51 cases demised, 27 cases survived, with a 30-days survival rate of 35%. The average survival time was 14.4 days (median: 8 days). The peak of death appeared within 3 days after ARDS. There were significant differences in aspects of age, primary disease, percentage of neonatal hyaline membrane disease, pediatric critical illness score (PCIS), duration of mechanical ventilation, oxygenation index (PaO2/FiO2), white blood cell count and number of involved organs between the died and survived children (P<0.05 or 0.01). The Cox multiple factors analysis showed that the age (HR 3.924~3.938), primary disease (HR=1.817) and PCIS (HR=0.469) were the risk factors of death. CONCLUSIONS: The peak of death usually appears within 3 days after ARDS. Age, primary disease and PCIS are the independent factors of prognosis in children with ARDS.

关键词

急性呼吸窘迫综合征 / 预后 / 儿童

Key words

Acute respiratory distress syndrome / Prognosis / Child

引用本文

导出引用
牛志民,李艳红,姜舜杰,毛向莹,李玉洁. 儿童急性呼吸窘迫综合征预后及其影响因素分析[J]. 中国当代儿科杂志. 2011, 13(7): 543-546
NIU Zhi-Min, LI Yan-Hong, JIANG Shun-Jie, MAO Xiang-Ying, LI Yu-Jie. Prognosis and its affecting factors in children with acute respiratory distress syndrome[J]. Chinese Journal of Contemporary Pediatrics. 2011, 13(7): 543-546
中图分类号: R725.6   

参考文献

[1]中华医学会呼吸病学分会.急性肺损伤/急性呼吸窘迫综合征的诊断标准(草案)[J].中华结核和呼吸杂志,2000,23(4):203.

[2]Ghaemi S, Mohamadymasodi M, Kelishadi R.表面活性物质替代治疗新生儿呼吸窘迫综合征的疗效评估[J].中国当代儿科杂志,2009,11 (3):188-190.

[3]常立文,李文斌.新生儿急性肺损伤/急性呼吸窘迫综合征[J].实用儿科临床杂志,2007,22(2):84-86.

[4]谢仰民.急性呼吸窘迫综合征大鼠肺病理组织电镜观察[J].中国比较医学杂志,2006,16(6):350-352.

[5]Relvas MS, Silver PC, Sagy M. Prone positioning of pediatric patients with ARDS results in improvement in oxygenation if maintained >12 h daily[J].Chest, 2003, 124(1): 269-274.

[6]翟亮,吴红敏,魏克伦,赵诗萌,姜红.新生儿呼吸窘迫综合征SP-A基因多态性的研究[J].中国当代儿科杂志,2008,10 (3):295-298.

[7]喻文亮,陆铸今,王莹,施丽萍,匡凤梧,张剑晖,等.小儿急性呼吸窘迫综合征前瞻性多中心临床流行病学研究[J].中华急诊医学杂志,2005,14(6):448-453.

[8]刘志刚,罗苇.呼吸指数及氧合指数动态监测在新生儿呼吸窘迫综合征中的应用[J].实用儿科临床杂志,2008,23(7):10741075.

[9]尹炽标,唐小平,张复春,唐漾波,许敏,陈燕清,等.54例重症严重急性呼吸综合征临床与预后因素分析[J].中国呼吸与危重监护杂志,2005,4(1):18-22.

[10]高建慧,韩玉昆,杨冰岩,金永源,龙晓玲,黄东明.足月新生儿急性呼吸窘迫综合征临床特征及预后[J].临床儿科杂志,2003,21(8):486-488.

[11]翁景文,刘红,李克华,刘靖媛,李云娟.新生儿急性呼吸窘迫综合征36例[J].实用儿科临床杂志,2004,19(10):384-385.

[12]宋国维.小儿危重病例评分[J].中华急诊医学杂志,2005,12(5):359-360.

[13]Thille AW, Richard JC, Maggiore SM, Ranieri VM, Brochard L.Alveolar recruitment in pulmonary and extrapulmonary acute respiratory distress syndrome: comparison using pressure-volume curve or static compliance[J].Anesthesiology, 2007, 106(2): 212-217.

[14]Rocco PR, Zin WA.Pulmonary and extrapulmonary acute respiratory distress syndrome: are they different?[J].Curr Opin Crit Care, 2005, 11(1): 10-17.

[15]庄海舟,段美丽,李昂,翁以炳.ICU中肺源性及肺外源性急性呼吸窘迫综合征患者治疗和预后的临床观察[J].中华老年多器官疾病杂志,2008,7(6):468-474.

PDF(1137 KB)

Accesses

Citation

Detail

段落导航
相关文章

/