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五岁以下重症肺炎患儿预后的危险因素
陈敏,王军,周雪典,陈馨蕊,田洁
0
(徐州医科大学第二附属医院儿科;徐州医科大学附属医院新生儿科)
摘要:
目的 探讨五岁以下重症肺炎患儿的临床治疗及影响预后的危险因素,为临床小儿重症肺炎的防治、诊治及预后提供理论依据。方法 收集2016年10月~2018年10月徐州医科大学第二附属医院住院部115例重症肺炎患儿的临床资料,回顾性分析所有患儿的临床资料、并发症及相关治疗,并采用Logistic回归分析其预后的危险因素。 结果 115例重症肺炎患儿中,呼吸性酸中毒42例(36.52%);低钠血症38例(33.04%)和低钙血症37例(32.17%);呼吸合胞病毒33例(28.69%);肺炎克雷伯杆菌11例(9.57%);胸部X线检查示斑片状阴影105例(91.30%),经治疗无效或加重者,80例行胸部CT检查示肺节段性不张44例(55.00%)。106例患儿出现并发症,其中47.17%患儿出现一种并发症,5283%患儿出现两种及以上并发症,所有患儿均使用抗生素治疗。使用与未使用机械通气患儿的预后比较,差异有统计学意义(P<0.05)。经单因素分析,入院前病程、转入重症监护室、有基础疾病、有并发症、贫血、电解质酸碱平衡紊乱、低白蛋白的患儿治疗有效率显著降低(P<0.05)。经多因素Logistic回归分析,入院前病程、转入重症监护室、有基础疾病、有并发症、贫血、电解质酸碱平衡紊乱、低白蛋白均为影响重症肺炎患儿预后的独立危险因素(P<0.05)。结论 重症肺炎患儿的病情复杂多样,入院前病程、转入重症监护室、基础疾病、并发症、贫血、电解质酸碱平衡紊乱、白蛋白均为影响重症肺炎患儿预后的独立危险因素,应积极治疗,有效给予对症干预,以改善患儿预后,降低患儿病死率。
关键词:  儿童  重症肺炎  临床特点  预后  危险因素
DOI:
基金项目:江苏省科技厅自然科学基金(BK20150217)
Analysis of risk factors affecting the prognosis of children with severe pneumonia below 5 years old
CHEN Min,WANG Jun,ZHOU Xuedian,CHEN Xinrui,TIAN Jie
(The Second Affiliated Hospital of Xuzhou Medical University;Department of Neonatology, The Affiliated Hospital of Xuzhou Medical University)
Abstract:
Objective To investigate the risk factors affecting the prognosis of children with severe pneumonia below5 years old and provide a theoretical reference for prevention, diagnosis and treatment of severe pneumonia in children. Methods The clinical data, clinical features, complications, and related treatments in 115 children with severe pneumonia in our hospital from October 2016 to October 2018 were retrospectively analyzed. Logistic regression analysis was used to analyze the risk factors for prognosis. Results Among 1115 children with severe pneumonia, there were 42 cases (36.52%) of respiratory acidosis,38 cases (33.04%) of hyponatremia, 37 cases (32.17%) of hypocalcemia, 33 cases of respiratory syncytial virus (28.69%) and 11 cases (9.57%) of Klebsiella pneumonia. Chest X-ray showed patchy shadow in 105 cases (91.30%). In 80 cases of severe pneumonia after treatment was invalid or aggravated. 44 cases(55%) showed pulmonary atelectasis by chest CT examination. 106 children with severe pneumonia had complications. The proportion was as high as 92.17% (106/115), of which 47.17% (50/106) had only one complication, 5283% (56/106) had more than two complications. All the children were treated with antibiotics. The difference in the prognosis of children with and without mechanical ventilation was statistically significant (X2=9.247, P=0.002). The univariate analysis showed that the treatment efficiency was significantly lower in children with severe pneumonia, such as course of disease before admission, transferred to intensive care unit, underlying disease, complications, anemia, electrolyte imbalance, and low serum albumin (P<0.05). 50 cases (4348%) were finally cured; Multivariate Logistic regression analysis showed that the course of illness before admission, transfer to intensive care unit, underlying disease, complications, anemia, electrolyte imbalance, low albumin were independent risk factors affecting the prognosis of children with severe pneumonia (P<0.05). Conclusion The condition of children with severe pneumonia is complex and diverse. The course of illness before admission, transfer to intensive care unit, underlying disease, complications, anemia, electrolyteimbalance, low albumin are independent risk factors affecting the prognosis of children with severe pneumonia. The active treatment and symptomatic intervention are of vital importance for improving the prognosis and reducing the mortality of children.
Key words:  Children  Severe pneumonia  Clinical features  Prognosis  Risk factors

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