中国25家儿科重症监护病房主要配置及住院状况调查分析  

Prospective,multicenter survey of clinical settings and admissions in 25 pediatric intensive care units in China

作　　者：喻文亮[1] 黄敬孚[2] 张国英[3] 祝益民[4] 刘春峰[5] 甘小庄[6] 刘政[7] 李昌崇[8] 樊寻梅[9] 孙波[1] 

机构地区：[1]复旦大学附属儿科医院 [2]天津市儿童医院,天津300074 [3]四川省成都市儿童医院,成都610017 [4]湖南省儿童医院,长沙410007 [5]中国医科大学盛京医院儿科,沈阳110004 [6]首都儿科研究所附属儿童医院,北京100020 [7]山西省儿童医院,太原030013 [8]浙江省温州医学院附属育英儿童医院,温州325027 [9]首都医科大学附属北京儿童医院,北京100045

出　　处：《中国循证儿科杂志》2007年第6期420-426,共7页Chinese Journal of Evidence Based Pediatrics

基　　金：上海市教委曙光跟踪计划(02GZ02);美国中华医学基金会资助项目(03-786)

摘　　要：目的调查中国儿科重症监护病房(PICU)的基本配置及住院患儿状况。方法应用问卷调查中国25家PICU的基本配置,应用儿童危重病例评分和美国PICU出入院指南,对2004年1月1日至2005年6月30日各PICU29d至14周岁住院患儿均进行为期12个月的危重病例筛选。结果中国25家PICU平均床位数(11.4±8.0)张,呼吸机数(6.1±3.7)台,44.0%(11/25)的PICU能进行中心静脉压监测。收治病例12018例,危重病例60.5%(7269/12018)。危重病例中内科疾病占76.9%(5590/7269),外科疾病占16.8%(1233/7269),其他科室疾病占6.3%(456/7269);平均住院日6.3d;肺炎41.4%(3013/7269),脓毒症9.5%(688/7269),外伤5.5%(397/7269),呼吸衰竭27.6%(2009/7269);行机械通气26.9%(1957/7269),行机械通气>24h17.9%(1300/7269),ARDS1.44%(105/7269)。研究期间,危重病例中病死率为6.7%(485/7269,95%CI:6.1%～7.3%),PICU中病死率为4.0%(485/12018,95%CI:3.7%～4.4%)。主要疾病病死率为1.3%～61.0%,不同PICU间收治患儿及病死率均存在差异。结论中国PICU配置仍处于初级水平,收治患儿标准及危重患儿病死率可能存在差异。Objective To investigate clinical settings and status of admissions in 25 pediatric intensive care units（PICU） in China.Methods Basic clinical settings were obtained from inquiry forms.From January 1st to June 30th,2005,all those 29 days to 14 years old children who were admitted to 25 PICU（each for 12 months） in China were prospectively surveyed by using a Chinese pediatric critical care scoring system and American guidelines for admission and discharge policies for PICU.Sepsis and organ dysfunction were identified by using criteria of Levy.Respiratory failure was defined as PaO2 〈 50 mmHg in room air at sea level or PaO2/FiO2 〈 250 mmHg under oxygen inhalation,in the absence of cyanotic congenital heart disease.Acute respiratory distress syndrome was identified by using American-European Consensus Conference definition.Results There were（11.4±8.0） beds and（6.1±3.7） ventilators in these settings.The highest bed/ventilator ratio was 7.5：1,and the lowest ratio was 1：2,and the mean value was 1.9：1.All beds were equipped with monitors for heart rates,respiratory rates,pulse oxygen saturation,etc.Central venous pressure monitoring could be executed in 44% PICU.None of PICU could execute pulmonary artery wedge pressure monitoring.Of the 12 018 patients admitted to the PICUs during the 12-month period,7 269 cases were defined as critical case,of whom 5 590（76.9%） were medical cases and 1 223（16.8%） were surgical ones and 456（6.3%） were the others.Average duration of hospital stay in the PICU for these critical cases was 6.3 days.Diagnoses were made as pneumonia in 3 013（41.4%）,non-pulmonary sepsis in 688（9.5%）,trauma in 397（5.5%）,respiratory failure in 2 009,and 1 957 were mechanically ventilated,1 300（17.9%） received mechanical ventilation over 24 h.105（1.44%） were acute respiratory distress syndrome.The mortality rate of critical case was 6.7%（485/7 269）（95%CI,6.10% to 7.27%）.The overall mortality of children in PICU was 4.0%（485/12 018）（95%CI,

关 键 词：儿科重症监护病房 配置 住院 流行病学 

分 类 号：R197.3[医药卫生—卫生事业管理]