Analysis of the prognosis and related influencing factors in children with severe pneumonia combined with respiratory failure
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摘要:
目的 总结重症肺炎合并呼吸衰竭患儿的临床特点，分析预后不良的影响因素以减少其发生。 方法 选取2020年12月—2022年12月新疆医科大学第一附属医院收治的110例重症肺炎合并呼吸衰竭患儿，根据病情转归分为预后良好组(82例)和预后不良组(28例)。收集患儿临床资料，采用logistic回归分析研究预后不良的影响因素。 结果 预后不良组患儿肺功能下降，动脉血气恶化。Logistic回归分析显示，年龄≤3岁(OR=1.292，95% CI: 1.068~1.516)、呼吸道反复感染(OR=3.904，95% CI: 3.414~4.394)、急性生理和慢性健康状况Ⅱ评分(APACHE Ⅱ评分)≥18分(OR=4.702，95% CI: 4.024~5.380)、未通气治疗(OR=2.004，95% CI: 1.594~2.414)、持续肺动脉高压(OR=4.600，95% CI: 3.884~5.316)、营养不良(OR=5.212，95% CI: 4.548~5.876)、低氧血症(OR=5.557，95% CI: 4.715~6.399)、重复插管(OR=5.114，95% CI: 4.450~5.778)、高碳酸血症(OR=3.501，95% CI: 2.897~4.105)、免疫功能低下(OR=3.789，95% CI: 3.065~4.513)均为患儿预后不良的危险因素(P<0.05)。 结论 重症肺炎患儿并发呼吸衰竭，可损伤肺功能，临床分析预后的危险因素并进行干预，可使患儿预后得到改善。 Abstract:Objective To analyze the clinical characteristics of children with severe pneumonia complicated with respiratory failure, find out the influencing factors of poor prognosis, and reduce its occurrence. Methods A total of 110 children with severe pneumonia complicated with respiratory failure admitted to the First Affiliated Hospital of Xinjiang Medical University from December 2020 to December 2022 were divided into a good prognosis group (82 cases) and a poor prognosis group (28 cases) according to the prognosis. The clinical data of children were collected, and the influencing factors of poor prognosis were analyzed by logistic regression. Results Pulmonary function decreased and arterial blood gas worsened in the poor prognosis group. Logistic regression analysis showed that age ≤3 years (OR=1.292, 95% CI: 1.068-1.516), repeated respiratory tract infection (OR=3.904, 95% CI: 3.414-4.394), acute physiology and chronic health evaluation-Ⅱ score (APACHE Ⅱ) score ≥18 points (OR=4.702, 95% CI: 4.024-5.380), non-ventilation therapy (OR=2.004, 95% CI: 1.594-2.414), persistent pulmonary hypertension (OR=4.600, 95% CI: 3.884-5.316), malnutrition (OR=5.212, 95% CI: 4.548-5.876), hypoxemia (OR=5.557, 95% CI: 4.715-6.399), repeated intubation (OR=5.114, 95% CI: 4.450-5.778), hypercapnia (OR=3.501, 95% CI: 2.897-4.105), immunosuppression (OR=3.789, 95% CI: 3.065-4.513) were the risk factors for poor prognosis (P<0.05). Conclusion Respiratory failure in children with severe pneumonia can damage their lung function. Clinical analysis of its risk factors and intervention can improve its prognosis. -
Key words:
- Severe pneumonia /
- Respiratory failure /
- Lung function /
- Influencing factor
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表 1 2组重症肺炎合并呼吸衰竭患儿血气指标对比(x±s)
Table 1. Comparison of blood gas indicators between two groups of children with severe pneumonia complicated with respiratory failure(x±s)
组别 例数 PaO2(mmHg) PaCO2(mmHg) SaO2(%) 预后良好组 82 70.25±8.33 40.25±5.31 93.25±1.85 预后不良组 28 57.36±6.85 58.15±6.87 87.25±2.03 t值 7.374 14.248 14.453 P值 0.001 0.001 0.001 
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表 2 2组重症肺炎合并呼吸衰竭患儿肺功能指标对比(x±s)
Table 2. Comparison of pulmonary function indicators between two groups of children with severe pneumonia complicated with respiratory failure(x±s)
组别 例数 FEV1(L) PEF(L/min) FVC(L) 预后良好组 82 2.14±0.32 123.25±23.01 2.59±0.34 预后不良组 28 1.19±0.21 93.48±11.18 2.11±0.32 t值 14.646 6.572 6.544 P值 0.001 0.001 0.001
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表 3 重症肺炎并发呼吸衰竭患儿预后转归的单因素分析[例(%)]
Table 3. Univariate analysis of prognosis and outcome in children with severe pneumonia complicated with respiratory failure[cases (%)]
项目 预后良好组(n=82) 预后不良组(n=28) 统计量 P值 性别 0.785 0.376 男 36(43.90) 15(53.57) 女 46(56.10) 13(46.43) 年龄(岁) 3.975 0.047 ＞3 50(60.98) 11(39.29) ≤3 32(39.02) 17(60.71) 呼吸道反复感染 6.899 0.009 是 35(42.68) 20(71.43) 否 47(57.32) 8(28.57) APACHE Ⅱ评分(分) 6.328 0.012 ≥18 36(43.90) 20(71.43) ＜18 46(56.10) 8(28.57) 昏迷 0.785 0.376 是 36(43.90) 15(53.57) 否 46(56.10) 13(46.43) 呼吸衰竭分型 0.102 0.749 Ⅰ型 38(46.34) 12(42.86) Ⅱ型 44(53.66) 16(57.14) 肺炎类型 0.192 0.662 社区获得性 40(48.78) 15(53.57) 医院获得性 42(51.22) 13(46.43) 通气治疗 5.512 0.019 是 53(64.63) 11(39.29) 否 29(35.37) 17(60.71) 持续肺动脉高压 8.263 0.004 是 30(36.59) 19(67.86) 否 52(63.41) 9(32.14) 营养不良 5.372 0.020 是 32(39.02) 18(64.29) 否 50(60.98) 10(35.71) 合并低氧血症 8.793 0.003 是 32(39.02) 20(71.43) 否 50(60.98) 8(28.57) 重复插管 7.603 0.006 是 31(37.80) 19(67.86) 否 51(62.20) 9(32.14) 合并高碳酸血症 10.221 0.001 是 30(36.59) 20(71.43) 否 52(63.41) 8(28.57) 免疫功能低下 4.852 0.028 是 33(40.24) 18(64.29) 否 49(59.76) 10(35.71)
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表 4 自变量赋值情况
Table 4. The assignment situation of independent variables
自变量 赋值方法 年龄 ＞3岁=0；≤3岁=1 呼吸道反复感染 否=0；是=1 APACHE Ⅱ评分 ＜18分=0；≥18分=1 通气治疗 是=0；否=1 持续肺动脉高压 否=0；是=1 营养不良 否=0；是=1 合并低氧血症 否=0；是=1 重复插管 否=0；是=1 合并高碳酸血症 否=0；是=1 免疫功能低下 否=0；是=1
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表 5 重症肺炎并发呼吸衰竭患儿预后转归的多因素logistics回归分析
Table 5. Multivariate logistic regression analysis of prognosis and outcomes in children with severe pneumonia complicated with respiratory failure
因素 B SE Waldχ2 P值 OR值 95% CI 年龄 0.882 0.448 3.867 0.049 2.415 1.003~5.814 呼吸道反复感染 1.211 0.474 6.523 0.011 3.357 1.325~8.503 APACHE Ⅱ评分 1.161 0.474 6.008 0.014 3.190 1.262~8.086 通气治疗 1.038 0.451 5.309 0.021 2.824 1.168~6.832 持续肺动脉高压 1.297 0.465 7.780 0.005 3.659 1.471~9.105 营养不良 1.034 0.455 5.171 0.023 2.812 1.153~6.858 合并低氧血症 1.363 0.476 8.206 0.004 3.906 1.538~9.923 重复插管 1.245 0.464 7.190 0.007 3.473 1.398~8.629 合并高碳酸血症 1.466 0.477 9.449 0.002 4.333 1.701~11.038 免疫功能低下 0.983 0.454 4.686 0.030 2.673 1.097~6.509
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