儿童麻疹并发重症肺炎临床特征及预后影响因素分析  

Analysis of Clinical Characteristics and Prognostic Factors of Children with Measles Complicated with Severe Pneumonia

作　　者：苗敏 王彩英 徐琳 赵扬 庞琳 MIAO Min;WANG Caiying;XU Lin(Department of Pediatrics,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院儿科,100015

出　　处：《医学研究杂志》2022年第11期160-164,193,共6页Journal of Medical Research

摘　　要：目的分析麻疹并发重症肺炎患儿的临床特征及预后影响因素,为其临床诊治及死亡风险评估提供依据。方法回顾性研究分析2009~2019年首都医科大学附属北京地坛医院儿科收治的118例麻疹并发重症肺炎患儿的临床资料。结果118例患儿中男患儿76例(64.4%),女患儿42例(35.6%),年龄中位数(四分位数)为8.43(6.25,11.31)个月,<2岁患儿最多,109例(92.4%)。未接种疫苗者106例(89.8%),有基础疾病者35例(29.7%),以反复呼吸道感染、先天性心脏病多见。所有患儿均有发热(高热占比72.9%)、皮疹、咳嗽,并发症以喉炎、呼吸衰竭(各占49.2%)最常见,肺气漏(13.6%)、急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)(8.5%)亦不少见。存活99例(83.9%)。死亡19例(16.1%),其中<1岁14例(73.7%),17例(89.5%)未接种疫苗,10例(52.6%)有基础疾病。死亡组呼吸衰竭、肺气漏、ARDS、心力衰竭、肾功能不全/肾衰竭、脓毒症、休克的发生率及转重症监护室(intensive care unit,ICU)率、机械通气率均高于存活组(P均<0.05)。多因素分析显示,有基础疾病(OR=7.555,P=0.018)、出现ARDS(OR=23.126,P=0.006)预示麻疹并发重症肺炎患儿不良预后可能性大。结论2岁以下婴幼儿是发生麻疹并发重症肺炎的主要人群,易并发呼吸衰竭、肺气漏、ARDS等严重并发症。有基础疾病,出现ARDS是麻疹并发重症肺炎患儿预后的影响因素,尤其ARDS并发肺气漏时增加死亡风险,临床应引起重视,做到早发现、早治疗,以降低病死率。Objective To analyze the clinical characteristics and prognostic factors of children with measles complicated with severe pneumonia,thus to provide basis for clinical diagnosis and treatment and death risk assessment.Methods Clinical data of 118 children with measles complicated with severe pneumonia admitted to Department of Pediatrics,Beijing Ditan Hospital,Capital Medical University from 2009 to 2019 were retrospectively analyzed.Results Among the 118 children,76(64.4%)were boys and 42(35.6%)were girls.The median age(quartile)was 8.43(6.25,11.31)months,and 109(92.4%)were under 2 years old.A total of 106(89.8%)children were not vaccinated against measles,and 35(29.7%)children had underlying diseases,predominantly recurrent respiratory tract infection and congenital heart disease.All the children had fever(high fever accounted for 72.9%),rash,cough,the most common complications were laryngitis and respiratory failure(49.2%respectively),pulmonary air leakage(13.6%)and acute respiratory distress syndrome(ARDS)(8.5%)were not uncommon.A total of 99(83.9%)children survived,and 19(16.1%)children died,of which 14(73.7%)were under 1 year old,17(89.5%)were not vaccinated,and 10(52.6%)had underlying diseases.The incidence of respiratory failure,pulmonary air leakage,ARDS,heart failure,renal insufficiency/renal failure,sepsis,shock,transfer to intensive care unit(ICU)and mechanical ventilation in death group were higher than those in survival group(P<0.05).Multivariate analysis showed that the possibility of poor prognosis was significantly associated with underlying diseases(OR=7.555,P=0.018)and ARDS(OR=23.126,P=0.006).Conclusion Infants under 2 years old are the main population of measles complicated with severe pneumonia,easily complicated with ARDS,pulmonary air leakage and other serious complications.The presence of underlying diseases and ARDS are the influencing factors for the prognosis of children with measles complicated with severe pneumonia,and especially ARDS complicated with pulmonary air leakage increases th

关 键 词：儿童 麻疹 重症肺炎 临床特征 预后 影响因素 

分 类 号：R72[医药卫生—儿科]