小儿呼吸机相关性肺炎的预后和病死率的危险因素分析  

Analysis of the prognosis and risk factors for mortality in children with ventilatorassociated pneumonia

作　　者：陈君[1] CHEN Jun(Department of Pediatric,People＇s Hospital,Deyang 618000,China)

机构地区：[1]德阳市人民医院儿科,四川德阳618000

出　　处：《武警后勤学院学报（医学版）》2018年第3期213-217,共5页Journal of Logistics University of PAP（Medical Sciences）

摘　　要：【目的】探讨呼吸机相关性肺炎(ventilator associated pneumonia,VAP)小儿患者病原菌、短期预后情况,并分析30 d病死率的危险因素。【方法】回顾性选择德阳市人民医院儿科自2010年1月至2014年12月VAP患儿51例,选择同期住院一般情况类似的未合并VAP的呼吸机辅助呼吸的患儿54例作为对照组,比较两组的住院期间临床情况,并应用Kaplan-Meier生存分析评价两组的随访30 d的生存情况,多元Logistic回归分析30 d病死率的危险因素。【结果】105例患者中,两组患儿的体质量、体温、呼吸频率、心率、白细胞(white blood cell,WBC)、C反应蛋白(C-reaction protein,CRP)、降钙素原(procalcitonin,PCT)、简化小儿危重病例评分(pediatric critical illness score,PCIS)等差异有统计学意义(P<0.05)。Kaplan-Meier生存分析两组间的生存时间差异亦有统计学意义(29.4%vs 9.2%,P<0.05),且住院时间、机械通气时间均有显著差异(P<0.05)。多元Logistic回归分析发现再插管(P=0.03)、机械通气时间(P=0.001)、PCIS(P=0.002)为预测VAP小儿30 d病死率的危险因素。【结论】VAP小儿预后差,短期病死率高。再插管、机械通气时间和PCIS为VAP小儿短期病死率的危险因素。【Objective】To investigate the pathogenic bacteria and short-term prognosis in children with ventilator-associated pneumonia（VAP） and analyze the risk factors for 30-day mortality.【Methods】Fifty-one children with VAP in People＇s Hospital of Deyang City were involved from January 2010 to December 2014 in the VAP group. And 54 patients without VAP were involved simultaneously in the control group. The basic clinical characteristics were compared between the two groups. Furthermore, the KaplanMeier survival analysis was used to evaluate the survival benefit of follow-up for 30 days, and the multiple logistic regression was used to evaluate the risk factors for mortality of 30-day follow-up.【Results】Of the 105 children enrolled, body weight, body temperature,rate of respiration, heart rate, count of WBC, C-reactive protein, PCT and PCIS were markedly different between the two groups（P〈0.05）. Meanwhile, Kaplan-Meier analysis showed that there was significant difference in survival time（29.4% vs 9.2%, P〈0.05） as well as length of stay and mechanical ventilation time between the two groups（P〈0.05）. Multiple logistic regression analysis demonstrated that the risk factors for 30-day mortality were as follows： re-intubation（P=0.03）, duration of mechanical ventilation（P=0.001） and PCIS（P=0.002）.【Conclusion】The prognosis of VAP is poor and its short-term mortality is high. Re-intubation, mechanical ventilation duration and PCIS are the risk factors for short-term mortality in children with VAP.

关 键 词：呼吸机相关性肺炎 小儿危重病例评分 机械通气 预后 

分 类 号：R725.6[医药卫生—儿科]