中国实用儿科杂志

中国实用儿科杂志 ›› 2023, Vol. 38 ›› Issue (11): 858-862.DOI: 10.19538/j.ek2023110611

• 论著 • 上一篇    下一篇

住院儿童重症肺炎390例死亡危险因素分析

  

  1. 1.温州医科大学附属第二医院 育英儿童医院儿童呼吸科，浙江  温州  325027；2.温州医科大学附属第三医院 儿科，浙江  温州  325200
  • 出版日期:2023-11-06 发布日期:2023-11-02
  • 通讯作者: 张海邻，电子信箱：zhlwz97@hotmail.com
  • 基金资助:
    浙江省医药卫生科技计划项目（2021KY213）；瑞安市科技计划项目（MS2022025）

Risk factors for death of 390 hospitalized children with severe pneumonia

  1. *Children's Respiratory Department，Yuying Children's Hospital；Second Affiliated Hospital of Wenzhou Medical University，Wenzhou  325027，China
  • Online:2023-11-06 Published:2023-11-02

摘要： 目的    了解温州某地区儿童重症肺炎死亡的危险因素。方法    回顾性分析2018年1月至2019年12月在温州医科大学附属第二医院住院的儿童重症肺炎病原，并收集患儿的基本信息、临床表现、实验室检查、影像学结果、治疗方案及短期预后情况。根据预后情况构建二分类Logistic回归模型，分析儿童重症肺炎死亡的危险因素。结果    收集重症肺炎患儿613例，剔除数据不完整的病例，共入组390例。其中男性患儿233例（59.7%），月龄中位数为9.0个月。213例（54.6%）有基础疾病，260例（66.7%）入住儿科重症监护室，32例（8.2%）死亡。254例（65.1%）至少检出1种病原，135例（34.6%）细菌培养阳性，118例（30.3%）检出呼吸道病毒，48例（12.3%）检出肺炎支原体。存活组和死亡组差异有统计学意义的指标包括基础疾病、发热、发绀、降钙素原、谷丙氨酸转移酶、乳酸脱氢酶、入住儿童重症监护室和需要机械通气等。多因素Logistic回归分析结果显示：需要机械通气（OR=7.78，95% CI：2.83，22.00）和基础疾病（OR=5.28，95% CI：1.65，23.20）是重症肺炎儿童死亡的危险因素。结论    需要机械通气和有基础疾病是重症肺炎儿童死亡的危险因素。

关键词: 重症肺炎, 儿童, 预后, 死亡, 危险因素

Abstract: Objective    To analyze the risk factors for death of severe pneumonia in children in Wenzhou. Methods    A retrospective analysis was conducted on pediatric patients diagnosed with severe pneumonia and admitted to the Yuying Children's Hospital，the Second Affiliated Hospital of Wenzhou Medical University，between January 2018 and December 2019. Clinical records encompassing patients' demographic details，clinical manifestations，laboratory examinations，radiological findings，therapeutic interventions，and short-term prognoses （survival and mortality） were collected. According to，a binary logistic regression model was formulated to assess the risk factors underpinning mortality in pediatric severe pneumonia cases. Results    A total of 613 cases of severe pneumonia in pediatric patients were assembled；after the exclusion of cases with incomplete data，390 cases were included in the study cohort. Among these，233 cases （59.7%） were male，with a median age of 9.0 months. Underlying diseases were present in 213 cases （54.6%），and 260 cases （66.7%） were admitted to the Pediatric Intensive Care Unit （PICU），with 32 cases （8.2%） resulting in mortality. At least one pathogen was detected in 254 cases （65.1%），bacterial cultures were positive in 135 cases （34.6%），respiratory viruses were detected in 118 cases （30.3%），and Mycoplasma pneumoniae was identified in 48 cases （12.3%）. The parameters with statistically significant differences between the survival group and mortality group  included underlying diseases，fever，cyanosis，procalcitonin levels，alanine aminotransferase levels，lactate dehydrogenase levels，PICU admission，and mechanical ventilation requirement. The multifactorial logistic regression analysis revealed the following results： the need for mechanical ventilation （OR=7.78，95% CI： 2.83，22.00） and underlying diseases （OR=5.28，95% CI： 1.65，23.20） were identified as risk factors for mortality in pediatric severe pneumonia. Conclusion    The need for mechanical ventilation and the presence of underlying diseases are risk factors for death in pediatric severe pneumonia in Wenzhou.

Key words: severe pneumonia, child, prognosis, death, risk factors