大叶性肺炎患儿多次行支气管镜下灌洗的危险因素分析  

Analysis of risk factors of multiple bronchoscopic lavage in children with lobar pneumonia

作　　者：王亚红 张有为 Wang Yahong;Zhang Youwei(Department of Pediatrics,Hubei Medical College Affiliated People′s Hospital,Shiyan 442000,China)

机构地区：[1]湖北医药学院附属人民医院儿科,十堰442000

出　　处：《中国医师进修杂志》2025年第4期348-352,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨大叶性肺炎患儿多次行支气管镜下灌洗的危险因素。方法回顾性分析2018年9月至2022年6月在湖北医药学院附属人民医院接受支气管镜下灌洗的184例大叶性肺炎患儿的临床资料,依据灌洗次数分为单次灌洗组(108例)和多次(≥2次)灌洗组(76例)。采用倾向性评分匹配(PSM)对两组进行1∶1匹配,匹配后采用多因素Logistic回归分析多次灌洗的危险因素,采用受试者工作特征(ROC)曲线分析危险因素对多次灌洗的预测作用。结果经PSM匹配后,共有68对患儿匹配成功。多因素Logistic回归分析结果显示,术前热程≥7 d、胸腔积液、降钙素原(PCT)≥2.0μg/L、白细胞计数(WBC)≥12.0×109/L、C-反应蛋白(CRP)≥10.0 mg/L、中性粒细胞比值(N%)≥70%、乳酸脱氢酶(LDH)≥300 U/L、红细胞沉降率(ESR)≥35.0 mm/1 h、血清丙氨酸氨基转移酶(ALT)>40 U/L、血清白蛋白(ALB)<35 g/L、黏液栓是大叶性肺炎患儿多次行支气管镜下灌洗的危险因素(OR=3.031、2.230、2.125、3.050、2.735、3.043、3.025、3.360、2.962、2.989、3.108,P<0.05)。ROC曲线分析结果显示,11项危险因素联合预测大叶性肺炎患儿多次行支气管镜下灌洗的灵敏度、特异度分别为72.10%、63.20%,曲线下面积为0.733。结论术前热程、胸腔积液、PCT、WBC、CRP、N%、LDH、ESR、ALT、ALB、黏液栓均为大叶性肺炎患儿多次行支气管镜下灌洗的危险因素,综合评估上述危险因素对患儿多次行支气管镜下灌洗具有预测作用。ObjectiveTo explore the influencing factors of multiple bronchoscopic lavage in children with lobar pneumonia and evaluate its predictive value.MethodsThe clinical data of 184 children with lobar pneumonia who underwent bronchoscopic lavage in the Hubei Medical College Affiliated People′s Hospital from September 2018 to June 2022 were retrospectively analyzed.According to the number of lavage,they were divided into the single lavage group(108 cases)and the multiple(≥2 times)lavage group(76 cases).The two groups was matched in a 1∶1 ratio by using propensity score matching(PSM),and the influencing factors for multiple lavage after matching was analyzed by multivariate Logistic regression analysis.The predictive effect of risk factors on multiple lavage was analyzed by the receiver operating characteristic(ROC)curve.ResultsAfter PSM matching,a total of 68 pairs of children were successfully matched.According to multivariate Logistic regression analysis,the duration of preoperative fever≥7 d,pleural effusion,procalcitonin(PCT)≥2.0μg/L,white blood cell(WBC)≥12.0×109/L,C-reactive protein(CRP)≥10.0 mg/L,neutrophil ratio(N%)≥70%,lactate dehydrogenase(LDH)≥300 U/L,erythrocyte sedimentation rate(ESR)≥35.0 mm/1 h,serum alanine aminotransferase(ALT)>40 U/L,serum albumin(ALB)<35 g/L and mucus thrombus were risk factors for multiple bronchoscopic lavage in children with lobar pneumonia(OR=3.031,2.230,2.125,3.050,2.735,3.043,3.025,3.360,2.962,2.989,3.108,P<0.05).According to ROC curve analysis,the sensitivity and specificity of the combination of 11 influencing factors in predicting multiple bronchoscopic lavage in children with lobar pneumonia were 72.10%and 63.20%respectively,and the area under the curve was 0.733.ConclusionsThe duration of preoperative fever,pleural effusion,PCT,WBC,CRP,N%,LDH,ESR,ALT,ALB and mucus thrombus are all influencing factors for multiple bronchoscopic lavage in children with lobar pneumonia,and comprehensive evaluation of the above influencing factors has predictive effect on

关 键 词：大叶性肺炎 支气管镜 危险因素 倾向性评分匹配 

分 类 号：R725.6[医药卫生—儿科]