需有创通气的重症肺炎患儿合并感染后闭塞性毛细支气管炎的临床特点及危险因素分析  

The clinical features and risk factors of children with post-infectious bronchiolitis obliterans treated with invasive mechanical ventilation because of severe pneumonia

作　　者：李晓卿[1] LI Xiao-qing(Department of PICU, Tianjin Children’s Hospital, Tianjin 300134, China)

机构地区：[1]天津市儿童医院PICU,300134

出　　处：《天津医药》2017年第8期881-884,共4页Tianjin Medical Journal

摘　　要：目的探讨需有创通气的重症肺炎患儿合并感染后闭塞性毛细支气管炎(PBO)的临床特点及危险因素,为临床早期诊断、早期治疗,改善PBO患儿的预后提供临床参考。方法收集2010年10月—2015年12月因重症肺炎需有创通气治疗入住我院儿童重症监护病房(PICU)并最终诊断为PBO的患儿为PBO组,抽取同期住院的需有创通气的重症肺炎患儿作为对照组。对2组患儿的一般特征、临床表现、就诊时间、治疗情况、病原学分布及相关检查结果等进行统计分析。采用SAS 9.3统计分析软件进行统计学处理。结果共73例患儿纳入研究,男49例,女24例,年龄1~36个月,中位8(4,12)个月。其中PBO组30例,对照组43例。喘息(27例,90.0%)、持续咳嗽(22例,73.3%)、运动不耐受(22例,73.3%)是PBO患儿的主要临床表现,患儿的体征以哮鸣音(24例,80.0%)、湿啰音(21例,70.0%)为主。肺CT以马赛克灌注征(25例,83.3%)最为突出;超过2/3的患儿肺功能中重度异常。PBO组患儿病原学检出率为50%,以病毒为主,其中呼吸道合胞病毒4例、流感病毒1例、麻疹病毒2例、腺病毒4例。多因素Logistic回归分析显示,病初用激素(OR=8.515,95%CI:1.948~37.224)、机械通气时间长(OR=1.116,95%CI:1.031~1.327)、就诊时间晚(OR=1.114,95%CI:1.010~1.227)是发生PBO的危险因素。结论就诊时间晚、病初用激素且机械通气时间长的重症肺炎患儿一旦出现喘息、持续咳嗽、运动不耐受、肺内哮鸣音和/或湿啰音持续存在等情况,应尽早行PBO的相关检查以明确诊断,早期治疗。Objective To summarize the clinical features and risk factors of children with post-infectious bronchiolitisobliterans(PBO),who were treated with invasive mechanical ventilation because of severe pneumonia,and to provide clinicalreference for early diagnosis,early treatment and improvement of prognosis of pediatric patients with PBO.Methods Thepediatric patients treated with invasive mechanical ventilation because of severe pneumonia,who were hospitalized in PICUof Tianjin Children’s Hospital from October2010to December2015were included in this study.The pediatric patients whowere diagnosed with PBO were used as the observation group.The general characteristics,clinical presentation,treatmenttime,treatment results,distribution of pathogens and relevant laboratory examination results were analyzed by using SAS9.3statistical software.Results A total of73pediatric patients were included in this study,including49male and24female,and their mean age was8months(P25-P75:4-12),the minimum age was1month and the maximum age was36months.Theywere divided into PBO group(n=30)and control group(n=43).It was found that wheezing(27cases,90.0%),persistentcough(22cases,73.3%)and exercise intolerance(22cases,73.3%)were the main clinical symptoms in PBO group.Resultsof physical examination showed wheeze(24cases,80.0%)and crackles(21cases,70.0%).Mosaic perfusion(25cases,83.3%)was the most prominent sign in lung CT scan.More than2/3of the pediatric patients were found moderate and severepulmonary dysfunction.Pathogen detection rate was50%in PBO group,and virus was prevalent(respiratory syncytial virus4cases,influenza virus1case,measles virus2cases and adenovirus4cases).The results of Logistic multivariate regressionanalysis showed that the risk factors included using corticosteroids at the beginning of disease(OR=8.515,95%CI:1.948-37.224),prolonged mechanical ventilation(OR=1.116,95%CI:1.031-1.327)and postponing clinic time(OR=1.114,95%CI:1.010-1.227).Conclusion Once the severe pneumonia children,with the risk factors of using cortico

关 键 词：细支气管炎 闭塞性 肺炎 危险因素 儿童 感染后闭塞性毛细支气管炎 有创通气 临床特点 

分 类 号：R725.6[医药卫生—儿科]