中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2010年
2期
190-194
,共5页
胡晓光%钱素云%李昌崇%许峰%王莹%周东元%祝益民%陈爱勇%樊寻梅%孙波%中国小儿急性低氧性呼吸衰竭临床协作组
鬍曉光%錢素雲%李昌崇%許峰%王瑩%週東元%祝益民%陳愛勇%樊尋梅%孫波%中國小兒急性低氧性呼吸衰竭臨床協作組
호효광%전소운%리창숭%허봉%왕형%주동원%축익민%진애용%번심매%손파%중국소인급성저양성호흡쇠갈림상협작조
儿童%危重症%病死率%呼吸治疗
兒童%危重癥%病死率%呼吸治療
인동%위중증%병사솔%호흡치료
Pediatric%Critical care%Mortauty%Respiratory therapy%Intensive care units
目的 探讨26家医院小儿重症监护室(PICU)患者呼吸支持相关的预后之差异及影响因素.方法 多中心前瞻性临床协作研究,研究时间为2005年12月至2006年11月连续12个月,研究对象为29 d至15周岁的PICU患儿.患儿纳入后记录其基本情况、疾病诊断、治疗及预后等数据,汇总后分析不同PICU其患者预后及呼吸治疗的差异.结果 在研究期间,26家PICU共收治危重病例11521例,占PICU收治患者总数的70%,不同单位该比例从14%到98%.26家单位共纳入小儿低氧性呼吸衰竭(AHRF)病例461例,患病率4%,各单位AHRF患病率中位值4.7%(Qr:2.4%～7.1%).AHRF总病死率41.6%,26家PICU病死率中位值39.8%(四分位数间距22%～57%).AHRF病死率在大学附属医院低于非大学附属医院(37%vs.46%,x~2=4.16,P:0.04),经济发达地区低于欠发达地区医院(38%vs.46%,x~2=3.1,P=0.08).结论 我国不同地区及不同类别医院PICU危重病例及AHRF呼吸支持相关的预后存在较大差异.PICU所在医院的学术背景及地区经济发展水平是影响患者预后的两个重要原因.在开展提高PICU的呼吸支持治疗水平和AHRF生存率的干预性研究设计中应予考虑.
目的 探討26傢醫院小兒重癥鑑護室(PICU)患者呼吸支持相關的預後之差異及影響因素.方法 多中心前瞻性臨床協作研究,研究時間為2005年12月至2006年11月連續12箇月,研究對象為29 d至15週歲的PICU患兒.患兒納入後記錄其基本情況、疾病診斷、治療及預後等數據,彙總後分析不同PICU其患者預後及呼吸治療的差異.結果 在研究期間,26傢PICU共收治危重病例11521例,佔PICU收治患者總數的70%,不同單位該比例從14%到98%.26傢單位共納入小兒低氧性呼吸衰竭(AHRF)病例461例,患病率4%,各單位AHRF患病率中位值4.7%(Qr:2.4%～7.1%).AHRF總病死率41.6%,26傢PICU病死率中位值39.8%(四分位數間距22%～57%).AHRF病死率在大學附屬醫院低于非大學附屬醫院(37%vs.46%,x~2=4.16,P:0.04),經濟髮達地區低于欠髮達地區醫院(38%vs.46%,x~2=3.1,P=0.08).結論 我國不同地區及不同類彆醫院PICU危重病例及AHRF呼吸支持相關的預後存在較大差異.PICU所在醫院的學術揹景及地區經濟髮展水平是影響患者預後的兩箇重要原因.在開展提高PICU的呼吸支持治療水平和AHRF生存率的榦預性研究設計中應予攷慮.
목적 탐토26가의원소인중증감호실(PICU)환자호흡지지상관적예후지차이급영향인소.방법 다중심전첨성림상협작연구,연구시간위2005년12월지2006년11월련속12개월,연구대상위29 d지15주세적PICU환인.환인납입후기록기기본정황、질병진단、치료급예후등수거,회총후분석불동PICU기환자예후급호흡치료적차이.결과 재연구기간,26가PICU공수치위중병례11521례,점PICU수치환자총수적70%,불동단위해비례종14%도98%.26가단위공납입소인저양성호흡쇠갈(AHRF)병례461례,환병솔4%,각단위AHRF환병솔중위치4.7%(Qr:2.4%～7.1%).AHRF총병사솔41.6%,26가PICU병사솔중위치39.8%(사분위수간거22%～57%).AHRF병사솔재대학부속의원저우비대학부속의원(37%vs.46%,x~2=4.16,P:0.04),경제발체지구저우흠발체지구의원(38%vs.46%,x~2=3.1,P=0.08).결론 아국불동지구급불동유별의원PICU위중병례급AHRF호흡지지상관적예후존재교대차이.PICU소재의원적학술배경급지구경제발전수평시영향환자예후적량개중요원인.재개전제고PICU적호흡지지치료수평화AHRF생존솔적간예성연구설계중응여고필.
Objective To assess the impact factors on the prognosis of patients with acute hypoxemie respiratory failure treated with respiratory support in 26 pediatric ICUs.Method From December 2005 to November 2006,a nationwide study of acute hypoxemic respiratory failure patients was carried out,and data of the critically ill patients were collected prospectively for assessing factors related to prognosis associated with respiratory support.Results During the consecutive 12-month period,there were 11521 critically ill patients admitted,accounting for 70%of all the pediatric ICUs admissions(n=16 442).The proportions of critically ill patients varied greatly among the 26 pediatric ICUs,ranging from 14%to 98%.There were 461 patients identified as acute hypoxemic respiratory failure(AHRF),resulting in an average incidence of 4%(462/11 521),the median 4.7%(interquartile range was 2.4%～7.1%).Average mortauty rate of AHRF was 41.6%,and median 39.8%(22%～57%).The mortauty of AHRF in pediatric ICUs of prognosis hospitals affiliated to university was significantly lower than that of non-affiliated ones(37%vs.46%,X~2=4.16,P=0.04).Those from economically developed regions tended to have lower AHRF mortauty than those from developing ones(38%vs.46%,X~2=3.1,P=0.08).Conclusions There are significant variations of prognosis associated with respiratory support among hospitals from areas in different academic and/or economic settings that make different service quauties of pediatric critical care.The improvement of respiratory support technique for AHRF should take these variations into consideration for the overall prognosis assessment.
