小儿重症肺炎不同药物治疗下的严重并发症以及影响患儿死亡的危险因素分析

Analysis of severe complications and risk factors of death in children with severe pneumonia treated with different drugs

目的 分析小儿重症肺炎不同药物治疗下的严重并发症以及影响患儿死亡的危险因素。方法 集取2020年1月至2022年1月于浙江大学医学院附属儿童医院收治的152例小儿重症肺炎患儿作为研究对象,统计小儿重症肺炎不同药物治疗下的严重并发症,探究小儿重症肺炎不同药物治疗下影响患儿死亡的危险因素。结果 在收回问卷的152例小儿重症肺炎患儿中有31例在不同药物治疗下会引发严重并发症,发生率为20.39%。与死亡组比较,存活组的并发症发生率较低(P<0.05)。两组干预后1秒用力呼气容积/用力肺活量(FEV1/FVC)、1秒用力呼气容积(FEV1)、用力肺活量(FVC)表达均上升,且存活组高于死亡组(P<0.05)。单因素分析显示重症肺炎患儿在不同药物治疗下产生严重并发症与性别、发病时间、C反应蛋白、服用抗生素的种类、有无基础病无关(P>0.05);影响重症肺炎患儿在不同药物治疗下产生严重并发症与年龄、器官功能障碍或衰竭(≥2个)、是否有并发症、是否机械通气、感染病原菌株数、在院时间、肺部感染的范围、是否为营养不足导致、是否贫血、有无既往感染史有关(P<0.05)。以重症肺炎患儿在不同药物治疗下产生严重并发症为因变量(未出现并发症=0;出现并发症=1),选择单因素分析中P<0.05的变量进行多因素Logistics回归分析,结果显示,年龄、器官功能障碍或衰竭(≥2个)、是否有并发症、是否机械通气、感染病原菌、在院时间、肺部感染的范围、是否为营养不足导致、是否贫血、有无既往感染史为影响重症肺炎患儿在不同药物治疗下产生严重并发症的主要影响原因(P<0.05)。结论 机体器官功能障碍或衰竭、存有并发症、经机械通气、双肺叶炎性转变、感染病原菌为主要影响重症肺炎患儿在不同药物治疗下产生严重并发症的因素,且使得死亡率升高,应做到早预防早治疗,以增强治愈效率。

Objective To analyze the serious complications and risk factors of death of children with severe pneumo-nia under different drug treatments.Methods A total of 152 children with severe pneumonia admitted to the Children’s Hos-pital Affiliated to Zhejiang University School of Medicine from January 2020 to January 2022 were selected as the study sub-jects,and the serious complications of severe pneumonia in children under different drug treatments were counted to explore the risk factors affecting the death of children with severe pneumonia under different drug treatments.Results Among 152 children with severe pneumonia who received questionnaires,31 cases would cause serious complications under different drug treatment,with an incidence of 20.39%.Compared with the death group,the complication rate was lower in the survival group(P<0.05).The expressions of forced expiratory volume/forced vital capacity in 1 second(FEV 1/FVC),forced expiratory vol-ume in 1 second(FEV 1)and forced vital capacity in 1 second(FVC)were increased in both groups after intervention,and the expressions in survival group were higher than those in death group(P<0.05).Univariate analysis showed that the occurrence of severe complications in children with severe pneumonia under different drug treatment was not related to sex,onset time,C-reactive protein,type of antibiotics taken,or underlying disease(P>0.05).The incidence of severe complications in children with severe pneumonia under different drug treatment was related to age,organ dysfunction or failure(≥2),whether there were complications,whether there was mechanical ventilation,number of pathogenic bacteria,length of hospital stay,scope of pulmonary infection,whether it was caused by nutritional deficiency,whether there was anemia,and whether there was a his-tory of infection(P<0.05).The incidence of severe complications in children with severe pneumonia under different drug treatments was the dependent variable(no complications=0;complications=1).Variables with P<0.05 in the univariate analysis are selected for multi-factor Logistics regression analysis.The results show that,age,organ dysfunction or failure(≥2 cases),whether there were complications,whether there was mechanical ventilation,infection with pathogenic bacteria,length of hospital stay,scope of pulmonary infection,whether it was caused by nutritional deficiency,whether there was anemia,and whether there was a history of infection were the main influencing factors of severe pneumonia in children under different drug treatment(P<0.05).Conclusion Body organ dysfunction or failure,complications,mechanical ventilation,inflammatory transformation of both lobe,infection with pathogenic bacteria are the main factors that affect serious complications in chil-dren with severe pneumonia under different drug treatment,and the mortality rate increases.Early prevention and early treat-ment should be done to enhance the cure efficiency.