苏州地区儿科重症监护病房呼吸道感染病例的临床分析

Clinical features of severe respiratory infected cases from pediatric intensive care unit in Suzhou,China

目的 归纳苏州大学附属儿童医院儿科重症监护病房（pediatric intensive care unit,PICU）5岁以下重症呼吸道感染病例的临床特征,探索影响患儿预后的危险因素.方法 根据医院信息系统（hospital information system,HIS）和PICU的出科纪录,检索2007年1月至2012年12月期间曾于PICU住院治疗的所有5岁以下重症呼吸道感染病例,回顾性收集病例的人口学资料、临床特征及住院转归等信息.比较≤6月龄及＞6月龄患儿的临床特征,对并发症及转归情况的危险因素进行单因素或多因素分析.结果 926例患儿列入研究,其中位年龄为4个月（IQR：2.0～10.8个月）,≤6月龄者占61.3％.18.2％患儿有基础疾病或早产史.咽红/咽痛（95.9％）、咳嗽（93.4％）为最常见的临床表现.并发症中呼吸衰竭占39.7％、心力衰竭占33.7％,有基础疾病及早产史的患儿多发（AOR=1.456,95％CI：1.009～2.107）.另外,有基础疾病及早产史的患儿住院时间更长（x2=14.7,P＜0.001）、治愈和好转率更低（AOR=0.721,95％CI：0.578～0.900）.≤6月龄患儿也较＞6月龄者住院时间更长（x2=18.2,P＜0.001）、治愈和好转率更低（AOR=0.770,95％ CI：0.660～0.900）.结论 PICU的患儿临床表现以咳嗽、咽红/咽痛、发热、呼吸急促为主,且常伴有消化道症状.有基础疾病及早产史的PICU严重呼吸道感染患儿发生并发症的风险更高,基础疾病、早产史及≤6月龄不利于患儿的治愈或好转.

Objective To describe the clinical characteristics and explore risk factors concerning complications and outcomes about respiratory infections from pediatric intensive care unit （PICU） among children under 5 years old. Methods A retrospective study was conducted to extract information from hospital information system （HIS） about PICU respiratory infected patients from January 2007 to December 2012. Demographic data, clinical symptoms and outcomes were collected retrospectively,and then were compared between patients under and above 6 months old. Univariate and multivariate analysis were conducted to detect risk factors influencing complications and outcomes.Results A total of 926 cases were enrolled. The median age of the children was 4 months （ IQR ： 2.0 - 10.8）. And 61. 3% of them were under 6 months old. 18. 2% of the cases had history of medical condition or preterm birth. Pharyngalgia （95.9%） and coughing （93. 4%） were the most common symptoms. Respiratory failure and heart failure accounted for 39.7 %and 33.7 %, respectively. Children with medical condition were more likely to develop complications （OR = 1. 456,95 % CI： 1. 009 - 2. 107）,needed longer PICU stay for recovery （χ^2 = 14.7,P〈0. 001 ） and were less likely to recover （AOR = 0. 721,95% CI：0. 578 - 0. 900）. Also,children ≤6 months needed longer PICU treatment （χ^2= 18.2,P〈0. 001） and were less likely to recover （AOR = 0.770,95%CI：0. 660 - 0. 900） ,compared with children above 6 months. Conclusions PICU respiratory infected children tended to have pharyngalgia,coughing,fever and tachypnea as major symptoms. Children who had medical conditions or preterm birth had higher risk of complication. Medical condition, preterm birth and the age ≤6 months were risk factors of recovery and longer hospitalization during PICU.