2019年新型冠状病毒肺炎流行期间非疫区儿童重症监护病房患儿疾病谱变化及预后  

Disease spectrum and prognosis of children in pediatric intensive care unit in non-epidemic areas during Corona Virus Disease 2019 epidemic period

作　　者：程超[1] 许巍[1] Cheng Chao;Xu Wei(Pediatric Intensive Care Unit,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院儿内科PICU,沈阳110004

出　　处：《中国小儿急救医学》2021年第11期955-959,共5页Chinese Pediatric Emergency Medicine

基　　金：国家自然科学基金(81771621,81270726);辽宁省重点研发指导计划项目(2019JH8/10300023);辽宁省自然科学基金(20170541023);345人才工程计划;辽宁省科技重大专项计划(2020JH1/10300001)。

摘　　要：目的分析2019年新型冠状病毒肺炎(COVID-19)流行对非疫区PICU住院疾病谱、治疗方式和结局的影响,指导PICU的临床治疗工作。方法回顾性收集2019年2月1日至2019年5月30日(Ⅰ组)与2020年2月1日至2020年5月30日(Ⅱ组)中国医科大学附属盛京医院PICU收治的患儿的临床资料,分析感染和非感染疾病谱变化及就诊时间,比较各系统疾病和意外伤害疾病及重要治疗手段使用情况和全因病死率。结果Ⅰ组339例,Ⅱ组208例,Ⅱ组患儿总数较Ⅰ组减少38.6%。两组患儿入院24 h内儿童器官功能障碍评分(P-MODS)(P=0.894)差异无统计学意义,Ⅱ组入院24 h内小儿Logistic器官功能障碍评分-2(PELOD-2评分)为1(0,3)分,较Ⅰ组1(0,2)分高,差异有统计学意义(P=0.012)。Ⅱ组住院时间较Ⅰ组延长(P=0.192),其中Ⅱ组中休克组、意外伤害与中毒组两组的住院时间更长,且差异均有统计学意义(P=0.048,P=0.001)。Ⅱ组感染性疾病(肺炎、无菌性脑炎、脓毒症)病例数及比率均比Ⅰ组明显减少[176例(52.1%)比93例(44.5%),P=0.095]。神经肌肉疾病:无菌性脑炎由13.2%降至7.2%(P=0.028);非创伤性颅内出血由0.9%升至3.8%(P=0.017)。Ⅱ组与Ⅰ组有创介入治疗病例数相比较明显减少,其中无创呼吸机、血浆置换、纤维支气管镜至少减少50%以上,但差异均无统计学意义。Ⅰ组与Ⅱ组患儿发病到就诊平均时间分别为7(4,12)d、3(1,6)d,差异有统计学意义(P=0.002)。Ⅰ组病死率4.7%(16/339),Ⅱ组病死率3.4%(7/208),总病死率及主要引起死亡疾病的病死率差异均无统计学意义。结论新型冠状病毒肺炎疫情导致PICU收治患儿疾病谱发生特征性变化,感染性疾病明显减少,非感染性疾病如外伤、中毒仍是主要危重症儿童病因。疫情期间非疫区重症患儿的就诊、收住PICU时间以及全因病死率无明显变化,由此可见疫情并未对重症患儿的就诊、转诊、救治以及预后产生不良影响。Objective To analyze the influence of Corona Virus Disease 2019(COVID-19)epidemic on inpatient disease spectrum,treatment methods and outcomes in pediatric intensive care unit(PICU)in non-epidemic areas.Methods The clinical data of children admitted to PICU at Shengjing Hospital of China Medical University from February 1,2019 to May 30,2019(group Ⅰ )and from February 1,2020 to May 30,2020(group Ⅱ )were collected retrospectively.We analyzed the spectrum changes of infectious and non-infectious diseases,visiting time,as well as compared the diseases of various systems and accidental injuries,and the use of important treatment methods,all-cause mortality.Results There were 339 cases in group Ⅰ and 208 cases in group Ⅱ .The total number of patients in group Ⅱ decreased by 38.6%compared with group Ⅰ .There was no significant difference in pediatric multiple organ dysfunction score(P-MODS)(P=0.894)between two groups within 24 hours after admission,but pediatric logistic organ dysfunction score(PELOD)-2 in group Ⅱ [1(0,3)]was higher than that in group Ⅰ [1(0,2)]within 24 hours after admission,with statistical difference(P=0.012).The length of hospital stay in group Ⅱ was longer than that in group Ⅰ ,but there was no statistical difference.The length of hospital stay in shock group,accidental injury and poisoning group were 6(5.25,8.25)days and 9(6,16)days,respectively,with statistical differences(P=0.048,P=0.001).Compared with group Ⅰ ,the number and ratio of infectious diseases(pneumonia,aseptic encephalitis and sepsis)in group Ⅱ decreased significantly[176(52.1%)to 93(44.5%),P=0.095].Neuromuscular diseases:aseptic encephalitis decreased from 13.2%to 7.2%;non-traumatic intracranial hemorrhage increased from 0.9%to 3.8%,with statistical difference(P=0.028,P=0.017).Compared with group Ⅰ ,the number of invasive interventional therapy cases in group Ⅱ decreased significantly,among which non-invasive ventilator,plasma exchange and fiberoptic bronchoscope decreased by at least 50%,but there was n

关 键 词：新型冠状病毒肺炎 就诊时间 疾病谱 病死率 

分 类 号：R195.4[医药卫生—卫生统计学]