CAJ | 학술논문

目的：探讨婴幼儿重症肺炎的流行病学特点、临床特点、死亡相关危险因素,为提高婴幼儿重症肺炎的治愈率、降低病死率提供临床依据。方法采用回顾性研究的方法,收集2011年1月1日至2013年12月31日在成都市妇女儿童中心医院住院诊断为重症肺炎的婴幼儿患者,分析其流行病学特征、临床特点以及死亡高危因素等,并对临床特点及死亡相关因素进行单因素及多因素分析。结果(1)1411例婴幼儿重症肺炎患儿中,男∶女为1．8∶1；城乡比例1∶3．62；年龄29 d~3个月占总数的46．00%。冬春季节发病占62．93%,夏秋季节发病占37．07%。(2)平均住院日为(9．99±6．27) d,明显长于普通肺炎住院日。(3)64．21%的患儿患有基础疾病。(4)91．99%的患儿出现并发症。(5)细菌感染占71．44%,病毒感染占18．36%,支原体及其他病原体感染占2．48%,混合感染占7．73%。( 6 )总死亡44例,病死率3．12%,死亡患儿中小于3个月婴儿占死亡总数72．73%,3个月~3岁占死亡总数的27．27%。(7)死亡危险因素分析显示年龄小于3个月、先天性心脏病、反复感染、多重耐药菌感染、手术史、多器官功能损害以及有内环境紊乱为独立的危险因素。结论婴幼儿重症肺炎冬春季发病率较高,农村高于城市,大多数为细菌感染所致,婴幼儿多见,年龄越小发病率越高,病死率越高；大部分患儿患有基础疾病；容易出现并发症。年龄小于3个月、有先天性心脏病、反复感染、多重耐药菌感染、手术史、多器官功能损害以及有内环境紊乱是婴幼儿重症肺炎死亡的高危因素,对这类患儿应加强监护与防治,降低病死率。
목적：탐토영유인중증폐염적류행병학특점、림상특점、사망상관위험인소,위제고영유인중증폐염적치유솔、강저병사솔제공림상의거。방법채용회고성연구적방법,수집2011년1월1일지2013년12월31일재성도시부녀인동중심의원주원진단위중증폐염적영유인환자,분석기류행병학특정、림상특점이급사망고위인소등,병대림상특점급사망상관인소진행단인소급다인소분석。결과(1)1411례영유인중증폐염환인중,남∶녀위1．8∶1；성향비례1∶3．62；년령29 d~3개월점총수적46．00%。동춘계절발병점62．93%,하추계절발병점37．07%。(2)평균주원일위(9．99±6．27) d,명현장우보통폐염주원일。(3)64．21%적환인환유기출질병。(4)91．99%적환인출현병발증。(5)세균감염점71．44%,병독감염점18．36%,지원체급기타병원체감염점2．48%,혼합감염점7．73%。( 6 )총사망44례,병사솔3．12%,사망환인중소우3개월영인점사망총수72．73%,3개월~3세점사망총수적27．27%。(7)사망위험인소분석현시년령소우3개월、선천성심장병、반복감염、다중내약균감염、수술사、다기관공능손해이급유내배경문란위독립적위험인소。결론영유인중증폐염동춘계발병솔교고,농촌고우성시,대다수위세균감염소치,영유인다견,년령월소발병솔월고,병사솔월고；대부분환인환유기출질병；용역출현병발증。년령소우3개월、유선천성심장병、반복감염、다중내약균감염、수술사、다기관공능손해이급유내배경문란시영유인중증폐염사망적고위인소,대저류환인응가강감호여방치,강저병사솔。
Objective Through retrospective data analysis,we tried to further understand the epide-miological characteristics,clinical feature and death factors of infant and young children with severe pneumo-nia. Methods The study objects were inpatients( age between≥28 days and≤3 years) who were diagnosed severe pneumonia from 1 January,2011 to 31 December,2013 of the Chengdu Women′s and Children′s Cen-tral Hospital. We used retrospective case study to understand the epidemiology,clinical feature,death factors of infant and young children with severe pneumonia. And we used chi-square test and Logistic multivariate regression analysis to analyze the death factors of infants and young children with severe pneumonia. Results (1) Among 1 411 cases of severe pneumonia,the ratio of male and female was 1. 8∶1,and the ratio of urban and rural areas was 1∶3. 62. The proportion of less than 3 months old infant was 46. 00%. And 62. 93% infant and young children with severe pneumonia occurred in the spring and winter. (2) Average hospitalization time was (9. 99 ± 6. 27 ) days, longer than the hospitalization time of mild pneumonia patients. ( 3 ) A total of 64. 21% of infant and young children with severe pneumonia had basic diseases. (4)A total of 91. 99% of the infant and young children with severe pneumonia had complications. (5) The most common etiology of infant and young children with severe pneumonia was bacteria,the second was virus. (6) In all cases,there were 44 cases died. The mortality of infant and young children with severe pneumonia was 3. 12%. And 72. 73% of the death cases were infants less than 3 months old. (7) The results of Logistic multiple regression analysis showed that there were significant differences in age, congenital heart diseases, repeating infection history, multiple drug-resistant strains infection, surgical history, multiple organ dysfunction, internal environment disorder. Conclusion Infant and young children with severe pneumonia have the following characteristics:most of them occurred in the winter and spring, and come from rural more than from the city. The smaller the age, the incidence of a disease is higher,and the mortality is higher. Most of infant and young children with severe pneu-monia have basic diseases. Most of the infant and young children with severe pneumonia have complications. If having one of the following high-risk factors:less than 3 months old,congenital heart diseases,repeating infec-tion history,multiple drug-resistant strains infection,surgical history,multiple organ dysfunction,internal envi-ronment disorder,the infant with severe pneumonia should be intensively monitored and actively treated.