经鼻持续气道正压通气联合丙种球蛋白治疗儿童重症肺炎并呼吸衰竭疗效的影响因素  

Influencing factors of therapeutic effect of transnasal continuous positive airway pressure ventilation combined with gamma globulin intravenous drip on severe pneumonia and respiratory failure in children

作　　者：周巍玲 魏升云 张孝兴[1] ZHOU Weiling;WEI Shengyun;ZHANG Xiaoxing(Department of Pediatric Intensive Care,Baoji Municipal Maternity and Child Health Hospital,Shaanxi Baoji 721000,China)

机构地区：[1]宝鸡市妇幼保健院儿童重症科,陕西宝鸡721000

出　　处：《中国妇幼健康研究》2022年第2期76-80,共5页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨影响丙种球蛋白联合经鼻持续气道正压通气治疗儿童重症肺炎并呼吸衰竭疗效的因素。方法选择2017年9月至2020年9月宝鸡市妇幼保健院儿童重症科收治的150例重症腺病毒肺炎并呼吸衰竭的儿童作为研究对象,经鼻持续气道正压通气联合丙种球蛋白治疗后,根据治疗效果分为有效组(n=120)和无效组(n=30),对两组患儿的临床资料进行单因素和多因素分析。结果两组患儿的性别、体质量指数(BMI)、住院时间、持续发热时间、早产儿比例相比,差异无统计学意义(P>0.05);相比有效组,无效组年龄较小、机械通气时间较长、营养性贫血比例较高、治疗后白介素-2(IL-2)水平较低、治疗后C反应蛋白水平较高、抗生素使用时间较短、急性生理及慢性健康状况(APACHEⅡ)评分较低,差异有统计学意义(χ^(2)值介于4.265~19.047之间,P<0.05);多因素Logistic回归分析显示,年龄<2岁、机械通气时间≥4d、营养性贫血、治疗后IL-2<3mg/mL、治疗后C反应蛋白≥5mg/L是治疗无效的危险因素,其OR值及95%CI分别为3.163(1.368~7.317)、2.466(1.093~5.565)、3.000(1.160~7.757)、2.406(1.056~5.483)、2.667(1.132~6.280),P<0.05。结论年龄较小、机械通气时间较长、营养性贫血比例较高、治疗后IL-2水平较低、治疗后C反应蛋白水平较高是影响丙种球蛋白联合经鼻持续气道正压通气治疗重症肺炎并呼吸衰竭效果的危险因素,需减少患儿的机械通气时间、加强患儿的营养调理、增强免疫力。Objective To explore factors affecting efficacy of gamma globulin intravenous drip combined with transnasal continuous positive airway pressure(CPAP)ventilation on severe pneumonia and respiratory failure in children.Methods 150 children with severe adenoviral pneumonia(SAP)and respiratory failure who admitted to Department of Pediatric Intensive Care,Baoji Municipal Maternity and Child Health Hospital from September 2017 to September 2020 were selected as research subjects.The children were treated with transnasal CPAP ventilation combined with intravenous drip of gamma globulin.According to therapeutic effect,the children were divided into effective group(n=120)and ineffective group(n=30).Pediatric critical illness scoring(PCIS)was used to evaluate condition of the disease of the children.Single factor and multivariate analyses were used to analyze and compare clinical data of the children in the two groups.Results There were no statistically significant differences in gender,body mass index(BMI),length of hspital stay,duration of fever,and proportion of preterm infants between the two groups(all P>0.05).Compared with the children in the effective group,the children in the ineffective group were younger and had longer duration of mechanical ventilation,higher incidence of nutritional anemia,lower serum level of interleukin-2(IL-2)after treatment,higher level of C-reactive protein(CRP)after treatment,shorter use time of antibiotics and lower score in acute physiology and chronic health evaluation scoring system(APACHE II),and the differences were statistically significant(χ^(2) values were between 4.265 and 19.047,all P<0.05).The results of multivariate logistic regression analysis shown that age<2 years,mechanical ventilation time≥4 days,nutritional anemia,IL-2<3 mg/mL after treatment and CRP≥5 mg/L after treatment were all risk factors for treatment ineffectiveness.The OR(95%CI)=3.163(1.368-7.317),2.466(1.093-5.565),3.000(1.160-7.757),2.406(1.056-5.483)and 2.667(1.132-6.280)respectively,all P<0.05.Conclus

关 键 词：丙种球蛋白 儿童 重症腺病毒肺炎 经鼻持续气道正压通气 

分 类 号：R725.6[医药卫生—儿科]