重症监护病房重症肺炎婴儿死亡危险因素分析

Mortality Risk Factors for Infants with Severe Pneumonia in the Intensive Care Unit

目的分析重症监护病房(ICU)中重症肺炎婴儿的死亡危险因素。方法收集医院信息系统中儿科和新生儿科ICU 2012年1月1日至2017年1月1日收治的年龄不超过2个月的重症肺炎患儿的病历信息。采用SAS 9.4统计学软件分析数据,以患儿的一般资料、药物治疗方案、合并用药、合并疾病、临床结局等指标进行单因素分析,采用多因素Logistic回归分析法筛选出与患儿死亡相关的独立危险因素。结果共纳入604例重症肺炎患儿,其中死亡49例(8.11%)。多因素Logistic回归分析结果显示,出生体质量低于1.8 kg[OR=3.92,95%CI(1.50,10.23),P=0.002],极危重肺炎[OR=3.55,95%CI(1.39,9.09),P=0.008],进行机械通气[OR=5.06,95%CI(1.97,12.95),P<0.001],合并贫血[OR=5.61,95%CI(2.36,13.35),P<0.001],合并新生儿窒息[OR=6.03,95%CI(1.57,23.12),P=0.009],合并消化道出血[OR=3.73,95%CI(1.21,11.48),P=0.021],合用镇静催眠药[OR=4.32,95%CI(1.76,10.61),P<0.001]均为重症肺炎婴幼儿死亡的独立危险因素;合用微生态制剂为保护性因素,可显著降低患儿的死亡率[OR=0.24,95%CI(0.10,0.54),P<0.001]。结论重症肺炎疾病的严重程度、患儿的营养状态、合并疾病、临床治疗方案、合用药物等均可对重症肺炎婴儿的临床结局产生较大影响,医师和药师在临床治疗过程中应早期识别死亡危险因素,并建立相应的预防措施,以降低死亡率,提高合理用药水平和医疗质量。

Objective To analyze the mortality risk factors for infants with severe pneumonia in the intensive care unit(ICU).Methods The medical records of infants with severe pneumonia aged≤two months admitted to the pediatric intensive care unit(PICU)or neonatal intensive care unit(NICU)were collected from the hospital information system(HIS)from January 1st,2012 to January 1st,2017.The data were analyzed by the SAS 9.4 statistical software.The general data,drug treatment plan,combined medication,combined disease,clinical outcome and other indicators of infants were analyzed by the univariate analysis,and the independent risk factors related to children's death were screened by the Logistic multivariate regression analysis.Results A total of 604 infants with severe pneumonia were included,of which 49 cases(8.11%)died.Multivariate Logistic regression analysis showed that birth weight<1.8 kg[OR=3.92,95%CI(1.50,10.23),P=0.002],extremely critical pneumonia[OR=3.55,95%CI(1.39,9.09),P=0.008],mechanical ventilation[OR=5.06,95%CI(1.97,12.95),P<0.001],comorbidity including anemia[OR=5.61,95%CI(2.36,13.35),P<0.001],neonatal asphyxia[OR=6.03,95%CI(1.57,23.12),P=0.009],gastrointestinal hemorrhage[OR=3.73,95%CI(1.21,11.48),P=0.021],sedative-hypnotics[OR=4.32,95%CI(1.76,10.61),P<0.001]were independent mortality risk factors for infants with severe pneumonia.The combination of probiotics was a protective factor,which could significantly reduce the mortality of infants[OR=0.24,95%CI(0.10,0.54),P<0.001].Conclusion The severity of severe pneumonia,the nutritional status of infants,combined diseases,clinical treatment plans and combined drugs have a great impact on the clinical outcome of infants with severe pneumonia.Doctors and pharmacists should identify the mortality risk factors early during the clinical treatment and establish corresponding preventive measures to reduce mortality,improve the level of rational drug use and medical quality.