小儿重症肺炎并发心力衰竭的预测

Risk factors for predicting pediatric severe pneumonia complicated with heart failure

目的:探索重症肺炎患儿并发心力衰竭的相关危险因素,为小儿重症肺炎相关心力衰竭的预防和治疗提供依据。方法:选取本院2015-04—2019-04期间小儿重症肺炎病例,收集可能相关因素,采用Logistic回归分析各因素对心力衰竭发生的预测价值。结果:共纳入重症肺炎患儿94例(心衰组35例、对照组59例),心衰组合并先天性心脏病、心肌酶异常、中流量以上给氧比例高于对照组(均P<0.05);Logistic回归显示,合并先天性心脏病(OR=5.048,P=0.012)、心肌酶谱异常(OR=4.139,P=0.012)、中流量以上给氧(OR=12.836,P=0.000)3个因素组成的模型对重症肺炎患儿并发心力衰竭的阳性预测率为74.3%、阴性预测率为88.1%;心衰组重症时间较长(P<0.01),但预后良好。结论:合并先天性心脏病、心肌酶谱异常、需中流量以上给氧是重症肺炎患儿并发心力衰竭的危险因素,这类心力衰竭呈一过性、可逆性,通过积极内科治疗可获得良好疗效。

Objective:To study the related factors of heart failure in children with severe pneumonia,and provide evidence for early prevention and treatment of severe pneumonia-related heart failure in children.Method:The cases of severe pneumonia in children from April 2015 to April 2019 in our hospital were enrolled in this case-control study.Potential risk factors related to the occurrence of heart failure were collected.Logistic regression analysis was used to analyze the predictive value of each factor in the occurrence of pneumonia-related heart failure.Result:A total of 94 children with severe pneumonia were enrolled in this study,among which 35 ones with heart failure were classified into the heart failure group and the remaining 59 patients were in the control group.The ratio of combined with congenital heart disease,myocardial enzyme abnormalities,and the use of medium or high flow oxygen were higher in the heart failure group(P<0.05).Logistic regression showed that a model consisting of congenital heart disease(OR=5.048,P=0.012),myocardial enzyme abnormalities(OR=4.139,P=0.012)and the medium or high flow oxygen(OR=12.836,P=0.000)had positive predictive value of 74.3%and negative predictive value of 88.1%for severe pneumonia-related heart failure.Children in the heart failure group had a longer duration of serious illness(P<0.01),but the prognosis was fine.Conclusion:Congenital heart disease,myocardial enzyme abnormalities,and the medium or high flow oxygen supply were independent risk factors of severe pneumonia complicated with heart failure.This kind of heart failure was transient and reversible,and good prognosis could be achieved by the active treatment of primary disease and symptoms related to heart failure.