Abstract:

Objective    To analyze the clinical characteristics and prognosis of pneumonia complicated with acute respiratory distress syndrome（ARDS） in pediatric hematological patients in order to improve the clinical treatment level. Methods    The data of clinical symptoms，laboratory result，treatment，prognosis and risk factors of 35 hematological children with pneumonia and ARDS admitted between March 2012 and January 2015 in Department of Pediatrics，Sun Yat-sen Memorial Hospital，Sun Yat-sen University were retrospectively analyzed. Results    The 35 hematological children with  pneumonia and ARDS had high fever（71.4%），cough（85.7%），shortness of breath（88.6%），cyanosis（74.3%），three concave sign positive（74.3%） and lung rale（65.7%）. The level of PaO2/FiO2 decreased，chest X-ray showed patchy or patchy infiltrates，and diffuse exudation and large consolidation in severe cases. A total of 29 strains of pathogens were isolated，including 22 strains of gram-negative bacteria. In 35 ARDS children，23 cases died（65.7%），and the main cause of death was MODS（in 12 cases，52.2%）. The death cause was related to no remission in primary disease，MODS，shock，severe chest infiltration and the use of mechanical ventilation（P＜0.05），but not to the way of mechanical ventilation（P＞0.05）. Logistic regression analysis showed that MODS and shock were the independent risk factors of death（P＜0.05）. Conclusion    The hematological children with pneumonia and ARDS should get more attention for its high mortality. It can be diagnosed early according to the clinical symptoms and signs，the blood gas analysis and chest X-ray. MODS and shock are the independent risk factors of death.

Key words: children, hematological diseases, pneumonia, acute respiratory distress syndrome

摘要：

目的    分析血液病患儿肺炎合并急性呼吸窘迫综合征（ARDS）的临床特征及预后相关因素，提高临床治疗水平。方法　收集2012年3月至2015年1月在中山大学孙逸仙纪念医院儿科住院的血液病患儿肺炎合并ARDS 35例患儿的临床资料，对症状、体征、辅助检查结果、治疗及转归、死亡危险因素等进行统计分析。结果　35例血液病患儿肺炎合并ARDS时表现为高热（71.4%）、咳嗽（85.7%）、气促（88.6%）、发绀（74.3%）、三凹征阳性（74.3%）、双肺啰音（65.7%）。血气分析提示氧合指数（PO2/FiO2）不同程度降低，胸部X线表现点片状、斑片状浸润影，严重者为弥漫性渗出、大片实变。所有病例均行血、痰液的病原体培养，共培养细菌29株，其中革兰阴性菌22株。35例ARDS患儿经治疗后死亡23例（65.7%），导致死亡的主要原因为多器官功能障碍综合征（MODS），共12例（52.2%）。死亡原因与原发病未缓解、合并MODS、休克、肺部浸润严重、使用机械通气有关（P＜0.05），而与机械通气呼吸支持方式无关（P＞0.05）。经Logistic回归分析显示，MODS、休克为死亡独立危险因素（P＜0.05）。结论　血液病患儿肺炎合并ARDS时有较高的病死率，临床可通过症状体征、血气分析和胸部X线检查早期诊断，合并MODS及休克是死亡独立危险因素。

关键词: 儿童, 血液病, 肺炎, 急性呼吸窘迫综合征