小儿急性肺损伤的短期肺功能随访

Follow-up study on survivors of pediatric ALI in short time

目的 探讨急性肺损伤／急性呼吸窘迫综合征（acute lung injury／acuterespi ratory distresssyn—drome，ALJ／ARDS）存活患儿的肺功能情况。方法采用前瞻性队列研究，随访2005年11月1日至2006年11月1日北京儿童医院PICU收治的ALI／ARDS存活患儿3个月后的肺功能情况。按年龄分为0～3岁组，3～7岁组，7岁以上组。结果44例肺损伤患儿出院时存活36例（ARDS22例，ALI14例），其中失访3例，死亡12例，存活21例。存活者中5例因无任何症状拒绝来院复查，1例因患淋巴瘤合并脓毒症再次并发ARDS无法完成检查，共15例（其中11例小于3岁，4例大于7岁）完成了全部检查。纳入后3个月与出院前比较，12例患儿纳入后3个月无明显呼吸道不适，所有患儿肺功能均有所改善，潮气量及顺应性的改善有统计学意义（P〈0．05）。结论ALI／ARDS存活患儿大部分出院后3个月异常呼吸道症状及体征消失，多数幸存者存在肺功能异常，但比出院时有所好转。

Objective To study the pulmonary functions of pediatric ALI/ARDS（ acute lung injury/acute respiratory distress syndrome） survivors. Method A prospective cohort study of all survivors of ALI/ARDS in the PICU of Beijing Children＇s Hospital was performed. Patients were divided into three groups（0 -3 years of age, 3 7 years of age, and over 7 years of age） and followed up three months after diagnosis. Results There were 36 survivors in total of 44 ALI patients, three patients lost follow-up, 12 died and 21 survived. Five survivors refused to participate in the study because of asymptomatic, and one was unable to participate because of lymphoma combined with sepsis. A total of 15 children completed the whole survey （ 11 patients were less than 3 years old, and four were over 7 years of age）. Twelve patients had no discomfort in their respiratory tracts. Three months after being enrolled, the pulmonary functions of all children improved, especially in terms of tidal volume and respiratory compliance （P 〈 0.05）. Conclusions The abnormal respiratory symptoms and signs in most children disappeared three months after discharge. Most survivors still have pulmonary dysfunction at 3 monthes after discharge, but better than discharge.