儿童重症监护室48小时再插管患儿的临床特征  

Clinical characteristics of children reintubated within 48 hours in pediatric intensive care unit

作　　者：周辉[1] 杜俐佳 刘盼 柳宇鑫 杜岩 张铮铮 陈伟明 陆国平 Zhou Hui;Du Lijia;Liu Pan;Liu Yuxin;Du Yan;Zhang Zhengzheng;Chen Weiming;Lu Guoping(Department of Pediatric Intensive Care Unit,The Affiliated Taizhou People's Hospital of Nanjing Medical University,Taizhou 225300,China;Department of Pediatric Intensive Care Unit,Children's Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]南京医科大学附属泰州人民医院,泰州225300 [2]复旦大学附属儿科医院重症医学科,上海201102

出　　处：《中国小儿急救医学》2024年第3期183-188,共6页Chinese Pediatric Emergency Medicine

基　　金：国家重点研发计划(2021YFC2701800,2021YFC2701801);上海市卫生健康系统重点扶持学科项目(2023ZDFC0103)。

摘　　要：目的分析儿童重症监护室48 h再插管患儿的临床特征,探讨再插管患儿拔管失败的原因及预后。方法采用单中心回顾性研究。将2019年1月1日至2022年12月31日复旦大学附属儿科医院PICU 48 h内再插管患儿作为研究对象,排除非计划拔管、因外科手术再次插管和无拔管计划仅更换气管插管的患儿,回顾性分析其临床特征,总结拔管失败原因及预后。数据收集包括48 h再插管患儿主要疾病诊断、小儿危重病例评分(PCIS)、插管原因、插管前格拉斯哥昏迷评分(GCS)、再插管直接原因、机械通气时间和PICU住院时间、出PICU的结局及是否成功拔管。结果研究期间PICU共拔管2652例,48 h再插管87例(3.3%)。87例再插管患儿中,存活出PICU 63例(72.4%),院内死亡9例(10.3%),放弃治疗自动出院15例(17.2%)。存活出PICU患儿中,38例(60.3%)成功拔管,25例(39.7%)气管切开。再插管患儿的主要疾病诊断前3位是中枢神经系统疾病34例(39.1%)、下气道疾病18例(20.7%)和脓毒症9例(10.3%)。再插管的直接原因包括:中枢性呼吸衰竭28例(32.2%),下气道疾病21例(24.1%),上气道梗阻20例(23.0%),咳嗽无力和(或)吞咽障碍14例(16.1%),其他原因4例(4.6%)。首次拔管前机械通气时间≥7 d的患儿中,原发病以中枢神经系统疾病为首(55.6%),再插管直接原因以中枢性呼吸衰竭为主(40.0%),首次插管前GCS<8分的患儿比例更高(40%)。与出PICU时拔管成功患儿相比,拔管失败患儿GCS<8分的比例更高(32.7%比10.5%,P<0.05),首次拔管前的中位机械通气时间更长[239.0(123.0,349.0)h比68.5(19.0,206.0)h,P<0.05]且中位PICU住院时间更长[38(23,54)d比24(12,43)d,P<0.05]。再插管存活患儿中,存活出院患儿PCIS评分最高,院内死亡患儿最低,差异有统计学意义(P<0.05)。结论PICU气管插管拔管后48 h再插管率3.3%。再插管的直接原因主要包括中枢性呼吸衰竭、下气道疾病、上气道梗阻、咳嗽无力和(或)吞�Objective To analyze clinical characteristics of patients within 48 hours in pediatric intensive care unit(PICU),and investigate causes and prognosis of extubation failure in reintubation children.Methods A single-center retrospective study was conducted.Patients who were reintubated within 48 hours after extubation in PICU at Children's Hospital of Fudan University from January 1,2019 to December 31,2022 were retrospectively enrolled.Patients with unplanned extubation for various reasons which include re-intubation due to surgery and replacement of tracheal intubation were excluded.We analyzed the clinical characteristics,causes of extubation failure and prognosis.Main outcome measures included principal diagnosis,pediatric critical illness score(PCIS),the reason of intubation,the glasgow coma scale(GCS),the direct cause of reintubation,aeration time,hospitalization period,outcomes at PICU discharge and whether to extubate successfully.Results During the study period,a total of 2652 patients were extubated in PICU,and a total of 87 children were enrolled.Finally,63(72.4%)patients survived at PICU,nine(10.3%)patients died in hospital,and 15(17.2%)patients were discharged automatically.In the survival group,38(60.3%)patients were decannulated and 25(39.7%)patients underwent tracheotomy.The top three principal diagnosis in 87 cases were central nervous system disease[34(39.1%)cases],lower airway disease[18(20.7%)cases]and sepsis[nine(10.3%)cases].Of the 87 children,28(32.2%)patients were reintubated due to central respiratory failure,21(24.1%)patients were reintubated due to lower airway disease,20(23.0%)patients were reintubated due to upper airway obstruction,14(16.1%)patients were reintubated due to cough weakness and/or swallowing disturbance,and four(4.6%)patients were reintubated for other reasons.In children with mechanical ventilation duration≥7 days before first extubation,central nervous system diseases were the most common primary diseases,and it accounts for 55.6%.Central respiratory failure was the m

关 键 词：再插管 机械通气 拔管失败 儿童 

分 类 号：R720.597[医药卫生—急诊医学]