摘要
目的:调查PICU长期机械通气(PMV)患儿的临床流行病学资料,分析PMV的原发病,不同原发病PMV患儿的疾病特点及转归。方法:回顾性收集复旦大学附属儿科医院2019年1月至2020年12月PICU住院PMV患儿的临床资料。结果:PMV患儿46例,男18例(39.1%),女28例(60.9%)。中位年龄37(8,86)个月,中位体重15(7,20)kg。入院时儿童危重病例评分平均为84.2±7.7,氧合指数(PaO 2/FiO 2)平均为(245.5±99.8)mmHg(1 mmHg=0.133 kPa)。导致PMV的原发病:重症肺炎14例,重症脑炎8例,支气管肺发育不良5例,上气道梗阻/头面部畸形3例,肌无力3例,脑干肿瘤3例,线粒体脑肌病3例,脊肌萎缩症2例,Prader-Willi综合征2例,皮肌炎1例,严重脑外伤1例,中枢性低通气1例。呼吸机依赖原因:呼吸功能障碍24例,脑功能障碍16例,膈肌功能障碍6例。呼吸系统疾病导致的PMV较神经肌肉疾病导致的患儿月龄更低,早产率更高,入院时氧合指数更低,呼吸机治疗需要参数更高,差异均有统计学意义( P均<0.05)。神经肌肉疾病导致的PMV患儿入院时格拉斯哥昏迷评分更低,昏迷比例更高,差异均有统计学意义( P均<0.05)。最终,46例PMV患儿中,9例(19.6%)气管切开,23例(50.0%)顺利拔管脱离呼吸机,出院依赖有创呼吸机6例(13.0%),气管切开带管呼吸6例(13.0%)。PMV患儿中位机械通气时间为33(28,40)d,中位PICU住院时间为42(34,56)d,中位住院时间为51(41,65)d。好转出院27例(58.7%),转康复医院4例(8.7%),转回当地医院4例(8.7%),死亡或放弃后死亡11例(23.9%)。 结论:导致PICU患儿PMV的原因主要是呼吸功能障碍、脑功能障碍、膈肌功能障碍。50.0%的PMV患儿可撤离呼吸机出院,死亡或放弃后死亡占23.9%。
Objective To investigate the clinical epidemiological data of children with prolonged mechanical ventilation(PMV)in pediatric intensive care unit(PICU),and analyze the primary disease of children with PMV as well as the disease characteristics and prognosis of children with PMV under different kinds of primary disease.Methods The clinical data of hospitalized children with PMV in PICU at Children′s Hospital of Fudan University from January 2019 to December 2020 were retrospectively collected.Results A total of 46 children with PMV were collected.There were 18 males(39.1%)and 28 females(60.9%).The median age was 37(8,86)months and the median body weight was 15(7,20)kg.The average pediatric critical illness score at admission was 84.2±7.7,PaO2/FiO2 was(245.5±99.8)mmHg.The primary diseases leading to PMV were as follows:there were 14 cases of severe pneumonia,eight cases of severe encephalitis,five cases of bronchopulmonary dysplasia,three cases of upper airway obstruction/craniofacial deformity,three cases of myasthenia,three cases of brain stem tumor,three cases of mitochondrial encephalomyopathy,two cases of spinal muscular atrophy,two cases of Prader-Willi syndrome,one case of dermatomyositis,one case of severe brain injury,and one case of central hypoventilation.The causes of unable to withdraw ventilator were respiratory dysfunction in 24 cases,brain dysfunction in 16 cases,and diaphragm dysfunction in six cases.Compared with neuromuscular diseases,children with PMV caused by respiratory diseases had lower month age,higher preterm birth rate,lower PaO2/FiO2 ratio,higher parameters for ventilator treatment,and the differences were statistically significant(P<0.05).Children with PMV caused by neuromuscular diseases had lower Glasgow coma score and higher coma rate,and the differences were statistically significant(P<0.05).A total of nine(19.6%)cases underwent tracheotomy.A total of 23(50.0%)cases were successfully extubated from ventilator,six(13.0%)cases were dependent on invasive ventilator,and six(13.0%)c
作者
孙立波
沈伟杰
陆国平
张铮铮
陶金好
刘盼
张羿
秦妍
柳宇鑫
陈伟明
Sun Libo;Shen Weijie;Lu Guoping;Zhang Zhengzheng;Tao Jinhao;Liu Pan;Zhang Yi;Qin Yan;Liu Yuxin;Chen Weiming(Department of Critical Care Medicine,Children′s Hospital of Fudan University,Shanghai 201102,China;Department of Clinical Epidemiology,Children′s Hospital of Fudan University,Shanghai 201102,China)
出处
《中国小儿急救医学》
CAS
2022年第8期606-610,共5页
Chinese Pediatric Emergency Medicine
基金
上海申康医院发展中心促进市级医院临床技能与临床创新能力三年行动计划项目(SHDC2020CR4092)。
关键词
儿童重症监护病房
长期机械通气
流行病学
儿童
Pediatric intensive care unit
Prolonged mechanical ventilation
Epidemiology
Children
