儿童重症监护病房57例ARDS危险因素  

Risk factors for ARDS in 57 cases in pediatric intensive care unit

作　　者：姜楠楠 孙慧 JIANG Nannan;SUN Hui(Pediatric Intensive Care Unit,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;School of Pediatrics,Guizhou Medical University,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学附属医院儿童重症监护室,贵州贵阳550004 [2]贵州医科大学儿科学院,贵州贵阳550004

出　　处：《贵州医科大学学报》2025年第2期281-286,293,共7页Journal of Guizhou Medical University

基　　金：贵阳市科学技术局基金项目(筑科合20161001)。

摘　　要：目的分析儿童重症监护室(pediatric intensive care unit,PICU)儿童急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的危险因素。方法收集57例PICU的ARDS患儿的一般资料,包括性别、年龄、体质量、基础疾病、病因、合并症、影像学、氧合指数、住科时长、辅助通气及治疗情况等;比较不同年龄组患儿的病因构成比;分析不同转归情况组患儿ARDS分级与转归相关性;根据出科时转归情况分为生存组(n=43)与死亡组(n=14),单因素分析法比较2组患儿的一般情况;多因素logistic回归分析法进行死亡危险因素分析;通过ROC曲线分析评价死亡风险预测的准确性。结果57例患儿中男性占比59.6%,平均年龄(3.6±4.2)岁,病因包括肺源性因素(重症肺炎和误吸),肺外因素(严重肺外感染和创伤),其中肺源性因素占比50.9%,各年龄组病因构成比比较差异无统计学意义(P>0.05);PICU内死亡14例,病死率24.6%,病死率与ARDS严重程度呈正相关(rs=0.546,P<0.01);单因素分析结果表明,死亡组患儿的住科时长、有创通气时长、ARDS分级及合并休克、MODS、脓毒症均高于生存组,差异有统计学意义(P<0.05);重度ARDS是死亡独立危险因素,重度ARDS对死亡风险预测的AUC为0.811(95%CI为0.671~0.952)。结论直接肺损伤是ARDS发生的主要危险因素,间接肺损伤预后更差,休克、MODS、脓毒症为死亡的重要危险因素,重度ARDS为其独立危险因素,其对死亡有较高的预测价值。Objective To analyze the risk factors of children with acute respiratory distress syndrome(ARDS)in pediatric intensive care unit(PICU).Methods General data of 57 children with ARDS in PICU were collected,including gender,age,body mass,underlying diseases,etiology,complications,imaging,oxygenation index,length of stay,assisted ventilation and treatment.The etiological component ratio of different age groups was compared.The correlation between ARDS grade and outcome was analyzed in different outcome groups.The 57 children were divided into the survival group(n=43)and the death group(n=14),according to the outcomes at the time of discharge.The general conditions of the two groups were compared by single factor analysis.The risk factors of death were analyzed by multivariate logistic regression analysis.The accuracy of death risk prediction was evaluated by ROC curve analysis.Results Among the 57 cases,59.6%were males,with an average age of(3.6±4.2)years.The etiology included pulmonary factors(severe pneumonia and aspiration)and extrapulmonary factors(severe extrapulmonary infection and trauma),in which pulmonary factors accounted for 50.9%,and there was no statistical significance in the etiological component ratio among different age groups(P>0.05).There were 14 cases of death in PICU(24.6%).It was positively correlated with the severity of ARDS(r s=0.546,P<0.01).The results of univariate analysis showed that the length of hospital stay,invasive ventilation duration,ARDS grade and combined shock,MODS and sepsis in the death group were higher than those in the survival group,and the differences were statistically significant(P<0.05).Severe ARDS was an independent risk factor for death,and the area under curve(AUC)for severe ARDS was 0.811(95%CI was 0.671-0.952).Conclusion Direct lung injury is the main risk factor for ARDS,while indirect lung injury has a worse prognosis.Shock,MODS and sepsis are important risk factors for death,while severe ARDS is an independent risk factor,which showed high predictive value for

关 键 词：儿童 重症监护室 急性呼吸窘迫综合征 肺损伤 临床 危险因素 

分 类 号：R725.9[医药卫生—儿科]