小儿重症腺病毒肺炎并发气胸的危险因素分析

An analysis of risk factors for pneumothorax in children with severe adenovirus pneumonia

目的分析小儿重症腺病毒肺炎机械通气期间并发气胸的危险因素。方法收集重症腺病毒肺炎且予以机械通气105例患儿的临床资料,年龄6个月~3岁。其中,27例并发气胸(气胸组),78例未见气胸(非气胸组)。回顾性分析并发气胸的影响因素和两组患儿的临床转归。结果气胸组患儿存活率低于非气胸组(59.26%vs.83.33%)(P<0.05)。单因素分析显示,婴幼儿喘息或哮喘、营养不良、免疫功能低下及影像学改变与小儿重症腺病毒肺炎并发气胸密切相关(P<0.05)。多因素logistic回归分析结果显示,婴幼儿喘息或哮喘、营养不良、免疫功能低下及影像学改变是小儿重症腺病毒肺炎并发气胸的独立危险因素(P<0.05)。结论当重症腺病毒肺炎患儿存在婴幼儿喘息或哮喘病史、营养不良、免疫功能低下及影像学改变时,发生气胸的风险增加,临床上应进行早期干预,减少气胸的发生,提高临床治疗效果。

Objective To analyze the risk factors of pneumothorax during mechanical ventilation in the children with severe adenovirus pneumonia.Methods Clinical data of 105 children aged 6 months to 3 years old with severe adenovirus pneumonia underwent mechanical ventilation in PICU were collected,of whom 27 cases were complicated with pneumothorax(group A) amd 78 cases were not with pneumothorax(group B).The clinical outcomes of two groups and the factors influencing pneumothorax in group A were analyzed.Results The survival rate of group A was lower than that of group B(59.26% vs.83.33%)(P<0.05).Univariate analysis showed that the infantile with wheezing or asthma,malnutrition,immune dysfunction and imaging changes were closely associated with pneumothorax in children with severe adenovirus pneumonia(P<0.05).Multivariate logistic regression analysis showed that infantile wheezing or asthma,malnutrition,immune dysfunction and imaging changes were the independent risk factors for pneumothorax in the children with severe adenovirus pneumonia(P<0.05).Conclusion In severe adenovirus pneumonia children with infantile wheezing or asthma,malnutrition,immune dysfunction or imaging changes,the risk for pneumothorax is increased during mechanical ventilation.Early intervention should be carried out to reduce the occurrence of pneumothorax and improve the clinical outcomes.