儿童急性呼吸窘迫综合征预后及其影响因素分析

Prognosis and its affecting factors in children with acute respiratory distress syndrome

摘要:

目的：了解儿童急性呼吸窘迫综合征（ARDS）的预后，探讨影响其预后的相关因素。方法：纳入78 例 ARDS 患儿，追踪确诊后 30 d 内生存状况。结果：（1）78 例 ARDS 患儿中，死亡 51 例，生存 27 例，30 d 生存率为 35%，平均生存 14.4 d，中位生存时间 8 d，确诊 ARDS 后 3 d 内为死亡的高峰期。（2）死亡患儿和生存患儿在年龄、原发病、新生儿肺透明膜病的构成比、小儿危重病例评分（PCIS）、机械通气时间、氧合指数（PaO2/FiO2）、WBC 和受累器官数目方面差异存在统计学意义（P＜0.05或0.01）。Cox多因素分析显示年龄（HR 3.924~3.938）、原发病（HR=1.817）和 PCIS（HR=0.469）是发生死亡的危险因素。结论：ARDS 后 3 d 内是死亡的高危期。年龄、原发致病因素和 PCIS 是影响 ARDS 患儿预后的独立因素。

Abstract:

OBJECTIVE: To study the prognosis and the factors affecting the prognosis in children with acute respiratory distress syndrome (ARDS). METHODS: Seventy-eight children with ARDS were enrolled. The states of their survival within 30 days were followed-up. RESULTS: Of the 78 children with ARDS, 51 cases demised, 27 cases survived, with a 30-days survival rate of 35%. The average survival time was 14.4 days (median: 8 days). The peak of death appeared within 3 days after ARDS. There were significant differences in aspects of age, primary disease, percentage of neonatal hyaline membrane disease, pediatric critical illness score (PCIS), duration of mechanical ventilation, oxygenation index (PaO2/FiO2), white blood cell count and number of involved organs between the died and survived children (P<0.05 or 0.01). The Cox multiple factors analysis showed that the age (HR 3.924~3.938), primary disease (HR=1.817) and PCIS (HR=0.469) were the risk factors of death. CONCLUSIONS: The peak of death usually appears within 3 days after ARDS. Age, primary disease and PCIS are the independent factors of prognosis in children with ARDS.