儿童早期预警评分、无创血气监测和无创血流动力学监测对儿童重度CAP的预测价值  

Predictive values of the pediatric early warning score, non-invasive blood gas monitoring and non-invasive hemodynamic monitoring in severe community-acquired pneumonia in children

作　　者：贾小慧 刘丽[1] 李磊[1] 张海洋 许婉婷 白辉科 刘艳[1] 沈晓佳 王林[3] Jia Xiaohui;Liu Li;Li Lei;Zhang Haiyang;Xu Wanting;Bai Huike;Liu Yan;Shen Xiaojia;Wang Lin(Department of Pediatrics,Chengdu Second People's Hospital,Chengdu 610017,China;Pediatric Intensive Care Unit,West China Second University Hospital,Sichuan University,Chengdu 610041,China;Department of Pediatrics,Chengdu Qingbaijiang District People's Hospital,Chengdu610039,China)

机构地区：[1]成都市第二人民医院儿科,成都610017 [2]四川大学华西第二医院儿童重症医学科,成都610041 [3]成都市青白江区人民医院儿科,成都610039

出　　处：《国际呼吸杂志》2024年第11期1327-1333,共7页International Journal of Respiration

基　　金：成都市技术创新研发项目(2019-YF05-00140-SN);成都市医学科研课题立项项目(2020113)。

摘　　要：目的探讨儿童早期预警评分(PEWS)、无创血气监测和无创血流动力学监测对儿童重度社区获得性肺炎(CAP)的预测价值。方法本研究为横断面研究, 采用非随机抽样的方法收集2020年1月至2022年12月于成都市第二人民医院儿科、四川大学华西第二医院儿童重症医学科、成都市青白江区人民医院儿科住院的546例CAP患儿为研究对象。根据病情严重程度将患儿分为轻度CAP组(151例)、重症CAP组(315例)和极重症CAP组(80例)。收集并比较3组患儿入院时的动脉血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、乳酸]、PEWS、无创血气监测指标[经皮氧分压(TcPO_(2))、经皮二氧化碳分压(TcPCO_(2))]和无创血流动力学监测指标[校正流动时间、每搏输出量(SV)、每搏输出量指数(SVI)、心输出量(CO)、心指数(CI)、外周血管阻力(SVR)、外周血管阻力指数(SVRI)]。Pearson相关分析CAP患儿动脉血气分析指标与无创血气监测指标的相关性。绘制受试者操作特征(ROC)曲线分析PEWS对儿童重症CAP、极重症CAP的预测价值。逐步法多因素logistic回归分析儿童发生重度CAP的影响因素, 基于logistic回归得出的影响因素构建儿童发生重度CAP的预测模型并绘制ROC曲线。结果轻度CAP组男82例, 女69例, 年龄4.50(1.42, 11.58)岁;重症CAP组男177例, 女138例, 年龄1.83(0.66, 6.33)岁;极重症CAP组男44例, 女36例, 年龄1.08(0.11, 3.59)岁;3组患儿性别比较差异无统计学意义(χ^(2)=0.16, P>0.05);3组患儿年龄比较总体差异有统计学意义(H=143.96, P<0.001)。3组CAP患儿入院时PEWS、PaO_(2)、PaCO_(2)、乳酸、TcPO_(2)、TcPCO_(2)、SV、SVI、CO、CI、SVR和SVRI比较, 总体差异均有统计学意义(均P<0.05), 进一步两两比较结果显示, 极重症CAP组、重症CAP组PEWS、PaCO_(2)、乳酸、TcPCO_(2)、SVR和SVRI均高于轻度CAP组, 且极重症CAP组高于重症CAP组(均P<0.05);极重症CAP组、�Objective:To investigate the predictive values of the pediatric early warning score(PEWS),non-invasive blood gas monitoring and non-invasive hemodynamic monitoring in pediatric severe community-acquired pneumonia(CAP).Methods:This was a cross-sectional study.Between January 2020 and December 2022,a total of 546 children with CAP hospitalized in the Pediatrics of Chengdu Second People′s Hospital,the Pediatric Intensive Care Unit of West China Second University Hospital,Sichuan University and the Pediatrics of Chengdu Qingbaijiang District People′s Hospital were included by non-randomization sampling.According to the disease severity,they were divided into mild CAP group(151 cases),severe CAP group(315 cases)and critical CAP group(80 cases).Arterial blood gas indexes(arterial partial pressure of oxygen[PaO_(2)],arterial partial pressure of carbon dioxide[PaCO_(2)],lactic acid),PEWS,non-invasive blood gas monitoring indexes(transcutaneous oxygen pressure[TcPO_(2)],transcutaneous carbon dioxide pressure[TcPCO_(2)])and non-invasive hemodynamic monitoring indexes(flow time corrected,stroke volume[SV],stroke volume index[SVI],cardiac output[CO],cardiac index[CI],systemic vascular resistance[SVR]and systemic vascular resistance index[SVRI])of the three group were compared.Pearson correlation analysis was used to analyze the correlation between arterial blood gas and non-invasive blood gas monitoring indicators in children with CAP.The receiver operator characteristic(ROC)curve was drawn to analyze the predictive value of PEWS for severe CAP and critical CAP in children.Stepwise multivariate logistic regression was used to analyze the influencing factors of severe CAP in children.Based on the influencing factors obtained from logistic regression,a prediction model of pediatric severe CAP was constructed and its performance was examined by the ROC curves.Results:There were 82 males and 69 females in mild CAP group,aged 4.50(1.42,11.58)years old.There were 177 males and 138 females in severe CAP group,aged 1.83(0.66,6.3

关 键 词：肺炎 儿童 儿童早期预警评分 经皮氧分压 经皮二氧化碳分压 无创血流动力学监测 

分 类 号：R725.6[医药卫生—儿科]