高效价血浆治疗重症病毒肺炎患儿临床效果分析  

Clinical effect of high-titer plasma in the treatment of severe viral pneumonia in children

作　　者：彭红艳 陈飞燕 左云龙 党润 杨镒宇 Peng Hongyan;Chen Feiyan;Zuo Yunlong;Dang Run;Yang Yiyu(Pediatric Intensive Care Unit,Guangzhou Women and Children Medical Center,Guangzhou 510120,China)

机构地区：[1]广州市妇女儿童医疗中心儿童重症监护室(儿童院区),510120

出　　处：《中华急诊医学杂志》2020年第7期970-975,共6页Chinese Journal of Emergency Medicine

基　　金：广州市科技计划项目(201803040004)。

摘　　要：目的探讨高效价血浆治疗重症病毒肺炎患儿的临床效果。方法回顾性分析2016年1月至2019年6月广州市妇女儿童医疗中心重症监护病房收治的80例重症病毒肺炎患儿资料。根据是否用高效价血浆治疗,分高效价血浆组(n=40)和非高效价血浆组(n=40)。采用卡方检验或Fisher确切概率法、Mann-Whitney U检验比较两组患儿基本资料、感染指标、血气及呼吸机参数相关指标、治疗及预后情况。结果入组前高效价血浆组与非高效价血浆组年龄、性别、入院体质量、发病天数及发热天数差异无统计学意义(均P>0.05);两组患儿入组3 d内最差序贯器官功能衰竭评分(SOFA评分)、Murray肺损伤评分、胸片受累情况、脓毒症情况差异无统计学意义(均P>0.05)。两组患儿入组前、入组后(第3、7天)血液中白细胞、中性粒细胞、C反应蛋白水平差异无统计学意义(均P>0.05);两组患儿入组前、入组后(第1、3、7天)的动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、乳酸(Lac)、平均气道压(MAP)、氧合指数(P/F)、氧指数(OI)差异无统计学意义(均P>0.05)。两组治疗过程中使用免疫球蛋白、激素、纤维支气管镜、血液净化、高频呼吸机、肺表面活性物质、体外膜肺情况差异无统计学意义(均P>0.05)。两组使用有创呼吸机天数、住PICU天数、总住院天数差异无统计学意义(均P>0.05);但高效价血浆组在入组后体温降至正常时间较非高效价血浆组缩短(Z=-2.10,P=0.04),且存活率高于非高效价血浆组(85%vs 65%,χ2=4.27,P=0.04),差异有统计学意义;高效价血浆组平均每日费用较非高效价血浆组少,分别为3688.38元(2335.49,5741.51)元和3979.24元(2670.68,9992.62)元,但差异无统计学意义(Z=-1.35,P=0.18)。高效价血浆治疗过程中未见严重不良反应。结论高效价血浆治疗重症病毒肺炎能缩短发热时间、能提高存活率。高效价血浆可作为重症病毒肺炎安全有效Objective To explore the clinical effect of high-titer plasma in the treatment of severe viral pneumonia in children.Methods A total of 80 eligible children with severe viral pneumonia in intensive care unit of Guangzhou Women and Children Medical Center were enrolled in this retrospective study from January 2016 to June 2019,According to whether high-titer plasma was used or not,patients were divided into the high-titer plasma group(40 cases)and non-high-titer plasma group(40 cases).Chi-square test,Fisher's exact probability test and Mann-Whitney U test were used to compare the basic data,infection indicators,blood gas and ventilator parameters related indicators,treatment and prognosis of the two groups.Results There were no significant differences in age,sex,admission weight,onset days and fever days between the high-titer plasma group and non-high-titer plasma group before entering the study(all P>0.05);There were no significant differences in the worst SOFA score,Murray lung injury score,chest X-ray involvement and sepsis within 3 days(all P>0.05).There were no significant differences in white blood cells,neutrophils and c-reactive protein between the two groups before and after entering the study(day 3 and 7)(all P>0.05).There were no significant differences in arterial partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2),lactic acid(Lac),mean airway pressure(MAP),oxygenation index(P/F)and oxygen index(OI)between the two groups before and after entering the study(day 1,3 and 7)(all P>0.05).There were no significant differences in the use of immunoglobulin,hormone,fiberoptic bronchoscope,blood purification,high frequency ventilator,pulmonary surfactant and extracorporeal membrane between the two groups(all P>0.05).There were no statistical differences in the number of days using invasive ventilator,the number of days staying in PICU and the total length of hospital stay between the two groups(all P>0.05).There was shorter time of the body temperature decreased to normal time in the high

关 键 词：高效价血浆 重症病毒肺炎 腺病毒 流感病毒 

分 类 号：R725.6[医药卫生—儿科]