儿童重症监护室肺出血患儿发生死亡的影响因素

Contributing factors to mortality in child patients with pulmonary hemorrhage in pediatric intensive care units

目的探讨儿童重症监护室(PICU)肺出血患儿发生死亡的影响因素。方法收集84例PICU肺出血患儿的一般临床资料、病因(感染性疾病、血液系统疾病、心血管疾病等)、临床症状和体征(发热、喘息及呼吸困难等)、实验室检查[血红蛋白(HGB)、血小板(PLT)等]、影像学检查、小儿危重症评分(PCIS)、并发症、呼吸机治疗信息及住院期间结局(死亡和生存)等资料,采用多因素logistic回归分析PICU肺出血患儿死亡的影响因素。结果PICU肺出血患儿发生死亡56例,病死率为66.7%,以感染性疾病为主要病因,多以常见的临床症状(喘息、发热)及体征(肝大、肺部湿性啰音)首发起病;多因素logistic回归分析结果显示,PICU肺出血患儿并发休克、HGB≤70 g/L、PLT≤130×10^(9)/L、PCIS≤60分是PICU肺出血患儿死亡的影响因素(P<0.05)。结论PICU肺出血患儿发生死亡与并发休克及低水平PCIS、HGB、PLT密切相关。

Objective To investigate the contributing factors to mortality in child patients with pulmonary hemorrhage in the pediatric intensive care unit(PICU).Methods The general clinical data,etiology(infectious diseases,hematologic diseases,cardiovascular diseases,etc.),clinical symptoms and signs(fever,wheezing,and dyspnea,etc.),laboratory tests[hemoglobin(HGB),platelets(PLT),etc.],imaging studies,pediatric critical care scores(PCIS),complications,records on ventilator therapy,and in-hospital outcomes(death and survival)were collected from 84 child patients with pulmonary hemorrhage admitted to the PICU.Multivariate logistic regression analysis was used to analyze the contributing factors to mortality in child patients with pulmonary hemorrhage admitted to the PICU.Results A total of 56 fatalities occurred in child patients with pulmonary hemorrhage in the PICU,with a fatality rate of 66.7%,mainly caused by infectious diseases,mostly starting with common clinical symptoms(wheezing and fever)and signs(hepatomegaly and crepitation).Multi-variate logistic regression analysis identified child patients with PICU pulmonary hemorrhage complicated with shock,HGB≤70 g/L,PLT≤130×10^(9)/L,and PCIS≤60 points were significant predictors of mortality in child patients with pulmonary hemorrhage in PICU(P<0.05).Conclusion There was a close correlation between the occurrence of death,complicated shock and low levels of PCIS,HGB,and PLT in child patients with pulmonary hemorrhage in PICU.