儿童重症监护室儿童慢性危重症的病因组成及预后分析

Etiology composition and prognosis of pediatric chronic critical illness in a pediatric intensive care unit

目的探讨儿童重症监护室儿童慢性危重症(pediatric chronic critical illness,PCCI)的病因组成和转归。方法以2017年1月—2022年12月在广东医科大学附属东莞儿童医院儿童重症监护室住院并达到PCCI诊断标准的患儿为研究对象。根据患儿的病历资料及出院诊断,对其病因进行分类。收集并分析其住院期间相关临床资料。结果2017年1月—2022年12月儿童重症监护室3955例住院患儿中,有321例(8.12%)符合PCCI诊断标准。321例PCCI患儿中,最常见的病因为感染(71.3%,229例),其次为意外伤害(12.8%,41例)、手术后(5.9%,19例)、肿瘤/免疫系统疾病(5.0%,16例)、遗传/染色体疾病(5.0%,16例)。321例PCCI患儿中,好转出院249例(77.6%),家属要求出院37例(11.5%),在院死亡35例(10.9%)。死亡病例中,感染占74%(26/35),意外伤害占17%(6/35),肿瘤/免疫系统疾病占6%(2/35),遗传/染色体疾病占3%(1/35)。2017—2022年PCCI在儿童重症监护室疾病中的占比呈逐年上升的趋势(P<0.05)。321例PCCI患儿中,婴幼儿148例(46.1%),学龄前儿童57例(17.8%),学龄期儿童54例(16.8%),青春期儿童62例(19.3%),其中婴幼儿组占比最高(P<0.05)。以上4个年龄组在院病死率分别为14.9%(22/148)、8.8%(5/57)、5.6%(3/54)、8.1%(5/62),其中婴幼儿组病死率最高,但4个组比较差异无统计学意义(P>0.05)。结论PCCI在儿童重症监护室疾病中的占比越来越高,其主要病因为感染及意外伤害,引起PCCI患儿死亡最常见的病因为感染。PCCI患病人群以婴幼儿为主,婴幼儿患者在院病死率相对较高。

Objective To explore the etiology composition and outcomes of pediatric chronic critical illness(PCCI)in the pediatric intensive care unit(PICU).Methods The children who were hospitalized in the PICU of Dongguan Children's Hospital Affiliated to Guangdong Medical University and met the diagnostic criteria for PCCI from January 2017 to December 2022 were included in the study.The etiology of the children was classified based on their medical records and discharge diagnoses.Relevant clinical data during hospitalization were collected and analyzed.Results Among the 3955 hospitalized children in the PICU from January 2017 to December 2022,321 cases(8.12%)met the diagnostic criteria for PCCI.Among the 321 cases,the most common etiology was infection(71.3%,229 cases),followed by unintentional injury(12.8%,41 cases),postoperation(5.9%,19 cases),tumors/immune system diseases(5.0%,16 cases),and genetic and chromosomal diseases(5.0%,16 cases).Among the 321 cases,249 cases(77.6%)were discharged after improvement,37 cases(11.5%)were discharged at the request of the family,and 35 cases(10.9%)died in the hospital.Among the deaths,infection accounted for 74%(26/35),unintentional injury accounted for 17%(6/35),tumors/immune system diseases accounted for 6%(2/35),and genetic and chromosomal diseases accounted for 3%(1/35).From 2017 to 2022,the proportion of PCCI in PICU diseases showed an increasing trend year by year(P<0.05).Among the 321 children with PCCI,there were 148 infants and young children(46.1%),57 preschool children(17.8%),54 school-aged children(16.8%),and 62 adolescents(19.3%),with the highest proportion in the infant and young children group(P<0.05).The in-hospital mortality rates of the four age groups were 14.9%(22/148),8.8%(5/57),5.6%(3/54),and 8.1%(5/62),respectively.The infant and young children group had the highest mortality rate,but there was no statistically significant difference among the four groups(P>0.05).Conclusions The proportion of PCCI in PICU diseases is increasing,and the main causes are infection and unintentional injury.The most common cause of death in children with PCCI is infection.The PCCI patient population is mainly infants and young children,and the in-hospital mortality rate of infant and young children with PCCI is relatively high.