儿童重症监护病房肺出血临床分析  

Clinical features of pulmonary hemorrhage in children at pediatric intensive care unit

作　　者：杨雨航 裴亮[1] 王丽杰[1] 刘春峰[1] Yang Yuhang;Pei Liang;Wang Lijie;Liu Chunfeng(Pediatric Intensive Care Unit,Shengjing Hospital of China Medical University,Shenyang 110000,China)

机构地区：[1]中国医科大学附属盛京医院小儿重症监护病房,沈阳110000

出　　处：《中华实用儿科临床杂志》2019年第18期1377-1381,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(81372039);辽宁省科学技术计划项目(2014225017).

摘　　要：目的探讨儿科重症监护病房肺出血的流行病学及临床特点。方法回顾性分析2008年1月至2017年9月中国医科大学附属盛京医院小儿重症监护病房收治所有肺出血患儿的发病率、原发病、临床表现、不同原发病导致肺出血的临床特点。结果研究期间共有82例符合肺出血诊断标准,同期住院12 440例,肺出血发病率为0.66%。其中9例因资料不全未纳入分析,73例肺出血患儿中,男39例(53.4%),女34例(46.6%);年龄31(5,72)个月;14例好转出院(19.2%),17例在院死亡(23.3%),42例中途退出治疗。引起肺出血的原发疾病为重度心力衰竭17例(23.3%),急性呼吸窘迫综合征(ARDS)12例(16.4%),重度脓毒症10例(13.7%),血液系统疾病10例(13.7%),颅内出血5例(6.8%),心跳呼吸骤停5例(6.8%),凝血功能障碍5例(6.8%),肾脏系统疾病3例(4.2%),其他疾病6例(8.3%)。肺出血患儿中,73例出现呼吸困难、肺部湿啰音、血氧饱和度下降,43.8%(32/73例)合并出血倾向,49.3%(36/73例)合并休克,12.3%(9/73例)出现抽搐,64.4%(47/73例)需心肺复苏。ARDS组的呼气终末正压为(10.2±2.4)cmH2O(1 cmH2O=0.098 kPa),高于其他组(F=4.59,P<0.01)、吸入氧体积分数为(0.9±0.1)%,高于其他组(F=3.16,P<0.01);重度脓毒症组国际标准化比值为1.9±0.7,高于其他组(F=2.96,P<0.01);血液系统疾病的血小板为(52.0±46.8)×10^9/L,低于其他组(F=8.23,P<0.01);血红蛋白为(81.6±15.6)g/L,低于其他组(F=5.48,P<0.01)。61例胸部平片提示双肺透过度减低、多发渗出性病变,5例双肺纹理增强。结论肺出血是多种疾病的并发症,重度心力衰竭、ARDS、重度脓毒症、血液系统疾病是重症监护病房中肺出血的前4位原发病,不同病因导致肺出血的特点不同,对于存在出血倾向、肺部浸润患儿出现不明原因的心率增快、呼吸困难、肺部湿啰音,需高度警惕肺出血。Objective To investigate the epidemiology and clinical features of pulmonary hemorrhage in children at pediatric intensive care unit(PICU).Methods A retrospective cohort case analysis was performed in order to investigate the incidence,primary disease,clinical manifestations and clinical characteristics of pulmonary hemorrhage in children at PICU of Shengjing Hospital of China Medical University from January 2008 to September 2017.Results Among the 73 cases,39 cases were male(53.4%)and 34 cases were female(46.6%),and the average age was 31(5,72)months.The conditions of 14 cases(19.2%)were improved and discharged,17(23.3%)cases died during the hospitalization period,and 42 cases gave up treatment halfway.The primary causes of pulmonary hemorrhage included severe heart failure in 17 patients(23.3%),acute respiratory distress syndrome(ARDS)in 12 patients(16.4%),severe sepsis in 10 patients(13.7%),hematological diseases in 10 patients(13.7%),intracranial hemorrhage occurred in 5 patients(6.8%),cardiac arrest in 5 patients(6.8%),coagulation dysfunction in 5 patients(6.8%),renal disease in 3 patients(4.2%)and other diseases in 6 patients(8.3%).The symptoms of all cases(73 cases)of pulmonary hemorrhage included dyspnea,moist rales and decreased blood oxygen saturation.Nasal bleeding or coffee ground like material drawn out from nasal stomach tube could be found in 32 cases(43.8%,32/73 cases),36 cases(49.3%,36/73 cases)were complicated by shock and 9 cases(12.3%,9/73 cases)were combined with convulsions,and 47 cases(64.4%,47/73 cases)were given cardiopulmonary resuscitation.The positive end expiratory pressure in ARDS group was(10.2±2.4)cmH2O(1 cmH2O=0.098 kPa),which was higher than that in other groups(F=4.59,P<0.01).The oxygen concentration in acute respiratory distress syndrome group was(0.9±0.1)%,which was higher than that in other groups(F=3.16,P<0.01).International normalization ratio was 1.9±0.7 in severe sepsis group,which was higher than that in other groups(F=2.96,P<0.01).Blood platelets in hematological dis

关 键 词：肺出血 临床特点 重症监护 儿童 

分 类 号：R725.6[医药卫生—儿科]