CAJ | 학술논문

目的分析比较我国小儿重症监护室(PICU)危重呼吸衰竭患儿病死率及呼吸支持治疗的发展状况.方法前瞻性临床多中心流行病学调查,共有20个PICU参加此次研究,研究时间为2004及2006年度,研究对象为29 d至15周岁的PICU患儿,同时调查每个PICU的基本配置情况.比较不同年份PICU配置、患儿预后及呼吸治疗的差异,对患儿预后相关因素进行多元回归分析.结果与2004年度相比,2006年度PICU的床位总数及呼吸机数均有增长;但床单位面积无增长;收治的患儿中危重患儿比例有明显提高(69.0%vs.57.5%,x2=318,P<0.01);危重病例总病死率差异无统计学意义.多元回归分析发现,医师工作量大的PICU,其患儿病死率要低,线性趋势检验P=0.013.2006年度,急性呼吸窘迫综合征病死率有了明显的下降(39.7%vs.55.8%,x2=6.59,P<0.01),但通气比例及呼吸机参数差异无统计学意义.结论我国PICU小儿呼吸危重症的救治水平与科室规模及设施的增长同步发展.PICU危重病例的预后与PICU规模及医生工作量存在正相关关系.
목적 분석비교아국소인중증감호실(PICU)위중호흡쇠갈환인병사솔급호흡지지치료적발전상황.방법 전첨성림상다중심류행병학조사,공유20개PICU삼가차차연구,연구시간위2004급2006년도,연구대상위29 d지15주세적PICU환인,동시조사매개PICU적기본배치정황.비교불동년빈PICU배치、환인예후급호흡치료적차이,대환인예후상관인소진행다원회귀분석.결과 여2004년도상비,2006년도PICU적상위총수급호흡궤수균유증장;단상단위면적무증장;수치적환인중위중환인비례유명현제고(69.0%vs.57.5%,x2=318,P<0.01);위중병례총병사솔차이무통계학의의.다원회귀분석발현,의사공작량대적PICU,기환인병사솔요저,선성추세검험P=0.013.2006년도,급성호흡군박종합정병사솔유료명현적하강(39.7%vs.55.8%,x2=6.59,P<0.01),단통기비례급호흡궤삼수차이무통계학의의.결론 아국PICU소인호흡위중증적구치수평여과실규모급설시적증장동보발전.PICU위중병례적예후여PICU규모급의생공작량존재정상관관계.
Objective To determine the prevalence of mortality and respiratory support therapy evolved for severe respiratory failure in pediatric intensive care units(PICU)in China. Method Two sessions of prospective, multicentric, and descriptively epidemiological survey of acute respiratory distress syndrome(ARDS)was carried out in year 2004 and 2006,and survey of alveolar hypoventilation respiratory failure(AHRF)in 2006 by 20 PICUs in China. Data about severity, outcome and respiratory therapy of critically ill patients, as well as PICU facilities were documented prospectively. PICU facilities, patients' mortality and respiratory therapy in different years were compared. Mortality risk factors were analyzed by multivariate logistic regression. Results Compared with those data in year 2004,the number of PICU bed and ventilator increased in year 2006.But,there was no increase in area per bed in year 2006.Proportion of critically ill patients in 2006 was significantly higher than that in 2004(69.0%vs.57.5%,x2=318,P<0.01).There were no significant difference in mortalities of critically ill patients between these two years. According to multivariate regression analysis, mortality was lowered in PICU with increase in heavy working load of physicians, evidenced by linear trend test P=0.013.Mortality of ARDS in year 2006 was significantly lower than that in 2004(39.7%vs 55.8%,x2=6.59,P<0.01).Whereas there was no significant difference in ventilation mode,tidal volume and airway pressure level for ventilated patients between two years.Conclusions With increasing the capacity of PICU there was a significant improvement of treatment as reflected by outcome of ARDS.Mortality of PICU patients was inversely correlated to the working load done by physicians.