小儿急性呼吸窘迫综合征病死相关因素前瞻性多中心分析  

Prospective, multicenter study of mortality and risk factors in children with acute respiratory distress syndrome in 25 pediatric intensive care units in China

作　　者：喻文亮[1] 钱素云[2] 朱友荣[3] 侯新光[4] 李梅 汤定华[6] 李丽红[7] 密越群[8] 于毅[9] 樊寻梅[2] 孙波[1] 小儿ARDS协作组 

机构地区：[1]复旦大学附属儿科医院小儿呼吸与危重病实验室,上海200032 [2]首都医科大学附属北京儿童医院儿科重症监护病房 [3]江西省儿童医院儿科重症监护病房 [4]郑州市儿童医院儿科重症监护病房 [5]哈尔滨儿童医院儿科重症监护病房 [6]上海交通大学附属儿童医院儿科重症监护病房 [7]长春市儿童医院儿科重症监护病房 [8]上海交通大学附属新华医院儿科重症监护病房 [9]南京医科大学附属南京市儿童医院儿科重症监护室 [10]不详

出　　处：《中华医学杂志》2007年第46期3295-3297,共3页National Medical Journal of China

基　　金：上海市教委曙光跟踪计划基金(02SG02);美国中华医学基金会基金(03-786)

摘　　要：目的调查我国儿科重症监护病房中小儿急性呼吸窘迫综合征的病死率及死亡危险因素。方法应用小儿危重病例评分和美国儿科重症监护病房(PICU)入出院指南对2004年1月1日至2004年12月31日25家 PICU 29 d～14周岁院患儿进行危重病例筛选;应用1994年美欧标准对住院患者中的急性呼吸窘迫综合征(ARDS)病例进行诊断。结果危重病例7269例,ARDS 105例,病死64例,患病率1.44%,病死率、24 h 病死率分别为62.9%、35.9%。死亡相对危险性是 PICU平均水平的9.0倍。Logistic 模型分析示起病时胸片浸润影、小儿危重病例评分及动脉血二氧化分压(PaCO_2)可作为 ARDS 病死的独立相关因素(P 值分别为0.004,0.001,0.030)。结论小儿 ARDS是我国 PICU 中具有高病死率的危重症,起病时的胸片浸润影、小儿危重病例评分、PaCO_2是其主要死亡危险因素。Objective To investigate the mortality and predictors of outcome of children with acute respiratory distress syndrome （ARDS） in pediatric intensive care unit （PICU）. Methods ARDS cases were selected from the 12018 patients admitted in 25 pediatric intensive care units in China from January 1 to December 31, 2004, aged 29 days to 14 years, using the Chinese Pediatric Critical Index of Severity （PCIS） and American Guidelines for Admission and Discharge Policies for PICU. ARDS was diagnosed according to the 1994 American-European Consensus Conference criteria. Results 105 of the 12 018 patients （1.44%） were diagnosed as with ARDS. The overall moaality of ARDS was 61.0% （64/105）, 9 times as high as that of the 7269 severe cases in PICU. Logistic regression analysis showed that infiltration shadows in 2 -3 quadrants, pediatric critical illness score （PCIS）, and partial pressure of carbon dioxide （ PaCO2 ） at the onset of ARDS were independently associated with the mortality. Conclusion ARDS has a high risk of death, and the infiltration shadows in 2-3 quadrants, PCIS, and PaCO2 are independently associated with mortality.

关 键 词：呼吸窘迫综合征 死亡率 儿童 危险因素 

分 类 号：R725.6[医药卫生—儿科]