重庆西南地区儿童重症腺病毒肺炎死亡的危险因素分析

Risk factors for death in children with severe adenovirus pneumonia in southwest Chongqing

目的探讨儿童重症医学科(PICU)中重症腺病毒肺炎(SAP)死亡的危险因素,为临床合理治疗、减少不良结局发生提供参考依据。方法回顾性分析2018年8月至2019年9月在重庆医科大学附属儿童医院PICU住院的68例SAP患儿的临床资料,并按病情转归分为死亡组及存活组,收集患儿年龄、基础疾病、并发症、实验室检查结果等进行单因素分析,并对单因素分析有意义者行多因素Logistic回归分析。结果68例患儿中男50例,女18例,6个月~2岁46例(67.6%);春夏季节发病55例(80.9%);热峰超过39℃者61例(89.7%),发热超过2周者21例(30.9%);42例(61.8%)合并其他病原感染;均有严重程度不同的肺内和肺外并发症;死亡23例,病死率33.8%。单因素分析显示死亡组共患先天性心脏病(13例比9例)、谷丙转氨酶>100 U/L(12例比8例)、并发急性呼吸窘迫综合征(ARDS)(13例比9例)、严重肺外并发症的发生率(19例比14例)均高于存活组,差异均有统计学意义(均P<0.05)。多因素Logistic回归结果显示,合并先天性心脏病、并发ARDS、严重肺外并发症为死亡的独立危险因素(均P<0.05)。结论PICU中SAP患儿多见于6个月~2岁,春夏季节发病率高,热峰高、发热时间长,易合并其他病原感染,易出现其他系统并发症,病死率高。当共患先天性心脏病、并发ARDS、严重肺外并发症时,PICU中SAP患儿死亡的风险增加。

Objective To investigate the risk factors for death in children with severe adenovirus pneumonia(SAP)in pediatric intensive care unit(PICU),and to provide reference basis for clinical reasonable treatment and reducing the adverse outcome.Methods The clinical data of 68 children with SAP hospitalized in PICU,Children′s Hospital of Chongqing Medical University from August 2018 to September 2019 were retrospectively analyzed.They were divided into the death group and the survival group according to their condition.The age,basic diseases,complications and laboratory examination results of children were collected for univariate analysis,and multivariate Logistic regression analysis was performed for those with significant univariate analysis.Results Among the 68 children with SAP,50 were males and 18 were females,and 46 cases(67.6%)aged between 6 months and 2 years.Fifty-five cases(80.9%)of SAP occurred in spring and summer.There were 61 cases(89.7%)with the spike over 39℃and 21 cases(30.9%)had fever for over 2 weeks;42 cases(61.8%)were infected with mixed other pathogens.Intrapulmonary and extrapulmonary complications at varying severity were observed.There were 23 cases(33.8%)deaths.Univariable Logistic regression analysis showed that the rates of congenital heart disease(13 cases vs.9 cases),alanine transaminase>100 U/L(12 cases vs.8 cases),acute respiratory distress syndrome(ARDS)(13 cases vs.9 cases)and severe extrapulmonary complications(19 cases vs.14 cases)were significantly higher in the death group than those in the survival group(all P<0.05).Multivariate Logistic regression analysis showed that congenital heart disease,ARDS and severe extrapulmonary complications were independent risk factors for death in children with SAP(all P<0.05).Conclusions Children with SAP in PICU are mostly 6 months to 2 years old.SAP mainly occurs in spring and summer,which is featured by the high spike of fever,long duration of fever,easy to be infected with other pathogens,high incidences of systemic complications,and high mortality.The combination of congenital heart disease,ARDS and severe extrapulmonary complications increases the risk of death in children with SAP in PICU.