绵阳市中心医院儿内科PICU死亡病例分析  

Analysis of the death cases in pediatric intensive care unit of Mianyang central hospital

作　　者：王敏[1] 余静[1] 刘蓉[1] 管利荣[1] 董金容 李艳[1] 胡陶[1] 

机构地区：[1]四川省绵阳市中心医院,四川绵阳621000

出　　处：《中国医药科学》2015年第4期126-128,134,共4页China Medicine And Pharmacy

摘　　要：目的了解我院儿内科重症监护室（PICU）死亡病例构成,分析死亡原因,掌握死亡高危因素,提高危重症诊疗水平,降低死亡率。同时有助于提高儿内科尤其是PICU专业人员对儿科常见病、危重病的认识。方法将2008～2012年5年内在儿内科PICU死亡的63例病例,以第一诊断及直接死因进行回顾性分析。结果农村儿童死亡率明显高于城市,意外伤害全为1～3岁农村儿童。死亡的前五位病种共51例,以颅内感染最多,其次依次为重症肺炎、暴发性心肌炎、意外伤害、败血症,婴儿期以重症肺炎多见,伴有先心病、肺发育不良者尤其明显,7～14岁以颅内感染多见;24h内死亡占55.55%,3个及以上脏器衰竭的患儿死亡率明显升高,其中颅内感染以脑疝多见,暴发性心肌炎仅单一循环衰竭而快速死亡,败血症和意外事件以休克、肾功能衰竭最突出,衰竭出现最多的是循环衰竭,其次呼吸衰竭,再次是休克。结论需提高农村的医疗水平,应关注小儿肺炎,1～3岁农村儿童的意外伤害,学龄儿童的颅内感染,根据发病年龄、城乡、脏器损害不同,考虑病种可能有所不同而指导临床,在危重患儿的抢救中,应注意监测及维护脏器功能,尽量不发展到3个以上脏器衰竭,减少死亡率。Objective To understand composition of the death cases in our Pediatric intensive care unit（PICU）,analyze the cause of death,master the death risk factors,improve the level of diagnosis and treatment of critically ill patients and reduce mortality.At the same time help PICU professionals to improve the awareness of the pediatric diseases and critical disease. Methods 63 death cases from 2008 to 2012 in our PICU were analyzed retrospectively and statistically to the first diagnosis and direct cause of death. Results Mortality of children in rural areas is significantly higher than the city.The occurrence of accidents were all rural children aged 1-3.The first five diseases of the deaths were 51 cases with the most intracranial infection,followed by severe pneumonia,fulminant myocarditis,accidental injury,sepsis.The more common disease is severe pneumonia in infancy,especially associated with congenital heart disease and pulmonary hypoplasia.Intracranial infection is more common aged 7-14.Mortality was 55.55% within 24 hours.The mortality of cases with three or more organ failure was significantly higher.Herniation is more common in intracranial infection cases.Only a single circulatory failure can lead to rapid death in fulminant myocarditis.Shock and renal failure is the most prominent in sepsis and accidents.The largest is circulatory failure,followed by respiratory failure,shock again. Conclusion We need to enhance the level of medical care in rural areas and pay attention to the severe pneumonia in infancy,intracranial infection in school age children and accidental injury in rural children aged 1-3.According to the time of onset,location,age,organ damage,we need to consider the disease may be different so as to guide the clinical treatment.In the rescue of critically ill children,we should pay attention to the monitor and maintain the organ function,try not to develop three or more organ failure in order to reduce the mortality rate.

关 键 词：儿科 PICU 疾病 死亡 

分 类 号：R720.597[医药卫生—急诊医学]