儿童社区获得性肺炎临床特点及其死亡危险因素分析

Analysis of Clinical Characteristics and Risk Factors of Death in Children Community Acquired Pneumonia

目的探讨儿童社区获得性肺炎临床特点及其死亡危险因素。方法选择2015年1月至2018年1月在我院接受治疗的350例社区获得性肺炎患儿的临床资料进行回顾性分析。所有患儿均接受同一组医护人员在《儿童社区获得性肺炎管理指南(2013修订)》指导下所采取的综合治疗措施。在查阅相关参考文献和咨询专家的基础上对影响因素进行选择,主要包括一般资料及临床资料两个部分。结果两组患儿性别及基础病差异无统计学意义(P>0.05),存活组年龄明显大于死亡组,院前病程明显较死亡组短(P<0.05)。两组患儿体温、心率、白细胞、CRP、PCT、白蛋白、ALT差异均无统计学意义(P>0.05),死亡组在呼吸率、低血压率、胸腔积液率、多页病变率、中性粒细胞比值、BUN、FPG、SCr均明显高于生存组,而在Alb及PaO_2/FiO_2则明显低于生存组(P<0.05)。多因素分析结果显示:年龄、低血压、呼吸率、SCr、BUN、FPG及多页病变为儿童社区获得性肺炎死亡独立性危险因素(P<0.05)。结论儿童社区获得性肺炎患者死亡与年龄、低血压、呼吸率、SCr、BUN、FPG及多页病变有关,临床上应加强对上述因素的干预。

Objective To investigate the clinical features and risk factors of death in community-acquired pneumonia in children.Methods We retrospectively analyzed the clinical data of 350 children with community-acquired pneumonia who were treated in our hospital between January 2015 and January 2018.All patients received the same treatment measures adopted by the same group of medical staff under the guidance of the'Guidelines for community-acquired pneumonia in children(2013 Revision)'.On the basis of consulting relevant references and consulting experts,the influencing factors were selected,including general data and clinical data.Results There was no significant difference in gender and basic disease between the two groups(P>0.05).The survival group was significantly older than the death group,and the prehospital course was significantly shorter than that of the death group(P<0.05).There was no significant difference in body temperature,heart rate,white blood cells,CRP,PCT,albumin,and ALT between the two groups(P>0.05).The rate of respiratory rate,hypotension,pleural effusion,multi-page lesion rate in the death group was not significant.The granulocyte ratio,BUN,FPG and SCr were all significantly higher than those in the survival group,while those in Alb and PaO2/FiO2 were significantly lower than those in the survival group(P<0.05).Multivariate analysis showed that age,hypotension,respiration rate,SCr,BUN,FPG,and multiple-page lesions were independent risk factors for community-acquired pneumonia in children(P<0.05).Conclusion The death of children with community-acquired pneumonia is related to age,hypotension,respiration rate,SCr,BUN,FPG and multiple-page lesions.Clinical intervention should be strengthened.