危重呼吸衰竭患儿的救治与转归  

Treatment and outcome of severe respiratory failure in pediatric patients

作　　者：胡晓光[2] 喻文亮[3] 钱素云[4] 许峰[5] 王莹[6] 祝益民[7] 甘小庄[8] 樊寻梅[4] 孙波[1] 

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201102 [2]温州医学院附属第二医院 [3]南京医科大学附属南京市儿童医院 [4]首都医科大学附属北京儿童医院 [5]重庆医科大学附属儿童医院 [6]上海交通大学附属上海儿童医学中心 [7]湖南省儿童医院 [8]首都儿科研究所附属儿童医院

出　　处：《中华急诊医学杂志》2011年第5期459-463,共5页Chinese Journal of Emergency Medicine

基　　金：美国中华医学基金会资助项目（03-786）;上海市医学领军人才项目（LJ06038）

摘　　要：目的分析比较我国小儿重症监护室（PICU）危重呼吸衰竭患儿病死率及呼吸支持治疗的发展状况。方法前瞻陛临床多中心流行病学调查，共有20个PICU参加此次研究，研究时间为2004及2006年度，研究对象为29d至15周岁的PICU患儿，同时调查每个PICU的基本配置情况。比较不同年份PICU配置、患儿预后及呼吸治疗的差异，对患儿预后相关因素进行多元回归分析。结果与2004年度相比，2006年度PICU的床位总数及呼吸机数均有增长；但床单位面积无增长；收治的患儿中危重患儿比例有明显提高（69．0％VS．57．5％，X^2=318，P〈0．01）；危重病例总病死率差异无统计学意义。多元回归分析发现，医师工作量大的PICU，其患儿病死率要低，线性趋势检验P=0．013。2006年度，急性呼吸窘迫综合征病死率有了明显的下降（39．7％vs．55．8％，X^2=6．59，P〈0．01），但通气比例及呼吸机参数差异无统计学意义。结论我国PICU小儿呼吸危重症的救治水平与科室规模及设施的增长同步发展。PICU危重病例的预后与PICU规模及医生工作量存在正相关关系。Objective To determine the prevalence of mortality and respiratory support therapy e- volved for severe respiratory failure in pediatric intensive care units （PICU） in China. Method Two ses- sions of prospective, muhicentric, and descriptively epidemiological survey of acute respiratory distress syn- drome （ARDS） was carried out in year 2004 and 2006, and survey of alveolar hypoventilation respiratory failure （AHRF） in 2006 by 20 PICUs in China. Data about severity, outcome and respiratory therapy of critically ill patients, as well as PICU facilities were documented prospectively. PICU facilities, patients＇ mortality and respiratory therapy in different years were compared. Mortality risk factors were analyzed by multivariate logistic regression. Results Compared with those data in year 2004, the number of PICU bed and ventilator increased in year 2006. But, there was no increase in area per bed in year 2006. Proportion of critically ill patients in 2006 was significantly higher than that in 2004 （69.0% vs. 57.5% , X2 = 318 ,P 〈 0.01 ）. There were no significant difference in mortalities of critically ill patients between these two years. According to multivariate regression analysis, mortality was lowered in PICU with increase in heavy working load of physicians, evidenced by linear trend test P = 0. 013. Mortality of ARDS in year 2006 was signifi- cantly lower than that in 2004 （39.7% vs 55.8% , X2 = 6.59, P 〈 0.01 ）. Whereas there was no signifi- cant difference in ventilation mode, tidal volume and airway pressure level for ventilated patients between two years. Conclusions With increasing the capacity of PICU there was a significant improvement of treatment as reflected by outcome of ARDS. Mortality of PICU patients was inversely correlated to the working load done by physicians.

关 键 词：呼吸衰竭 儿童 重症监护 病死率 呼吸支持治疗 

分 类 号：R720.597[医药卫生—急诊医学]