280例CAP住院患儿病原学分析及其预后影响因素分析

Analysis of pathogens and factors influencing prognosis of 280 hospitalized children with community acquired pneumonia

目的分析社区获得性肺炎(CAP)住院患儿的病原学特点及影响其预后的因素。方法选择保定市儿童医院儿科于2014年2月-2016年9月收治的CAP患儿作为研究对象,同时根据治疗后的预后状况分为预后良好组和预后不良组。对入组患儿血液及呼吸道分泌物进行分离培养,鉴定其中病原微生物,同时采用多因素Logistic回归分析方法分析影响CAP患儿预后的因素。结果肺炎支原体是CAP住院患儿的主要病原。呼吸道合胞病毒是CAP住院患儿主要感染的病毒类型,占50%以上。肺炎链球菌感染是CAP住院患儿感染的最主要细菌类型。年龄<3岁(OR=0.298,95%CI:0.128~0.692)及心功能不全(OR=0.690,95%CI:0.555~0.858)是CAP住院患儿预后良好的不利因素;有创机械通气治疗(OR=2.257,95%CI:1.709~2.981),初始抗菌联合用药(OR=1.587,95%CI:1.135~2.219)是CAP住院患儿预后良好的有利因素。结论 CAP住院患儿病原构成比从高到低依次为支原体、病毒和细菌,有利于预后的因素包括有创机械通气和初始抗菌联合用药。

Objective To analyze the pathogens of community acquired pneumonia （CAP） of hospitalized children and the factors influencing prognosis. Methods A total of 280 CAP children hospitalized in Baoding Children′s Hospital from February 2014 to September 2016 were enrolled as the research subjects, and were divided into good prognosis group and poor prognosis group according to the treatment results. The blood and respiratory secretions were cultured to identify pathogenic microorganisms. And Logistics regression analysis was used to determine the influencing factors of CAP prognosis. Results Mycoplasma pneumoniae was the main pathogen of CAP in hospitalized children. Respiratory syncytial virus infection （over 50%） was main type of CAP virus. Streptococcus pneumoniae infection was the main type of CAP bacteria. Children under 3 years old（OR=0.298,95%CI：0.128～0.692）, the occurrence heart failure（OR=0.690,95%CI：0.555～0.858）were the unfavorable factors of good prognosis in hospitalized CAP children. Invasive mechanical ventilation treatment（OR=2.257,95%CI：1.709～2.981） and antibacterial drug combination（OR=1.587,95%CI：1.135～2.219）were favorable factors for initial prognosis of children with good hospital CAP. Conclusion The order from high to low of pathogens in hospitalized children with CAP is mycoplasma, viruses and bacteria. Factors beneficial to prognosis include invasive mechanical ventilation and initial antimicrobial drug combination.