儿童腺病毒肺炎并发呼吸衰竭的危险因素分析

Risk factors analysis of respiratory failure complicated by adenovirus pneumonia in children

目的探讨腺病毒感染致重症社区获得性肺炎患儿并发呼吸衰竭的临床特点和相关危险因素。方法回顾性分析2019年1月至12月江西省儿童医院收治的127例重症腺病毒肺炎(SAP)住院患儿的临床资料,根据有无并发呼吸衰竭分为呼吸衰竭组(n=51)和非呼吸衰竭组(n=76),选取同期住院的轻症腺病毒肺炎(AVP)患儿作为对照组(n=80),分析SAP患儿并发呼吸衰竭的危险因素。结果呼吸衰竭组、非呼吸衰竭组与对照组在热程、住院天数、患基础疾病情况、C反应蛋白(CRP)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、胸腔积液比例、肺实变比例、合并感染比例比较,差异均有统计学意义(P<0.05)。单因素分析结果显示,呼吸衰竭组和非呼吸衰竭组的热程、住院天数、CRP、AST、LDH、肌酐、血糖、白细胞(WBC)、中性粒细胞计数、血红蛋白(Hb)比较,差异有统计学意义(P<0.05);呼吸衰竭组与非呼吸衰竭组患基础疾病情况、胸腔积液比例、肺实变比例、合并感染比例比较,差异有统计学意义(P<0.001)。多因素logistic回归分析结果显示,热程>14.5 d(β=0.209,OR=1.233,95%CI=1.043~1.458)、住院天数>16.5 d(β=0.270,OR=1.309,95%CI=1.080~1.588)、患基础疾病(β=2.059,OR=7.839,95%CI=1.277~48.106)、CRP>14.9 mg/L(β=0.033,OR=1.033,95%CI=1.002~1.066)是SAP患儿发生呼吸衰竭的危险因素。结论SAP患儿热程、住院时间长于轻症腺病毒肺炎患儿,患胸腔积液、肺实变及合并感染比例、CRP、AST、LDH高于轻症腺病毒肺炎患儿。当SAP患儿存在发热持续时间长、住院治疗时间长、罹患基础疾病及CRP增高时,会增加发生呼吸衰竭风险,在临床上应进行早期评估病情及干预。

Objective To investigate the clinical characteristics and related risk factors of respiratory failure in children with severe community-acquired pneumonia caused by adenovirus infection.Methods Clinical data of 127 hospitalized children with severe adenovirus pneumonia(SAP)admitted to Jiangxi Provincial Children's Hospital from January to December 2019 were retrospectively analyzed.They were divided into respiratory failure group(n=51)and non-respiratory failure group(n=76)according to whether they had respiratory failure.Children with mild adenovirus pneumonia(AVP)hospitalized in the same period were selected as the control group(n=80),and the risk factors of respiratory failure in SAP children were analyzed.Results There were statistically significant differences among respiratory failure group,non-respiratory failure group and control group heat duration,hospital stay,underlying diseases,C-reactive protein(CRP),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),pleural effusion ratio,lung compactibility ratio and co-infection ratio(P<0.05).The results of univariate analysis showed that there were statistically significant differences in the respiratory failure group and the non-respiratory failure group in heat duration,hospital stay,CRP,AST,LDH,creatinine,blood glucose,white blood cell(WBC),neutral cell count,hemoglobin(Hb)(P<0.05),there were statistically significant differences in the respiratory failure group and the non-respiratory failure group in underlying diseases,pleural effusion ratio,lung compoundness ratio and co-infection ratio(P<0.001).The results of multi-factor logistic regression analysis showed that the heat duration>14.5 d(β=0.209,OR=1.233,95%CI=1.043-1.458),hospital stay>16.5 d(β=0.270,OR=1.309,95%CI=1.080-1.588),underlying diseases(β=2.059,OR=7.839,95%CI=1.277-48.106),CRP>14.9 mg/L(β=0.033,OR=1.033,95%CI=1.002-1.066)were risk factors for respiratory failure in children with SAP.Conclusion Heat duration and hospital stay of children with SAP are longer than those of children with mild adenovirus pneumonia,and pleural effusion ratio,lung consolidation ratio and co-infection ratio,CRP,AST and LDH values are higher than those of children with mild adenovirus pneumonia.When children with SAP have long heat duration,long hospital stay,underlying diseases and increased CRP,it will increase the risk of respiratory failure,and early assessment and intervention should be carried out in clinical practice.