中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2015年
8期
548-553
,共6页
王叶青%钱素云%王晓晖%王荃%方伯梁
王葉青%錢素雲%王曉暉%王荃%方伯樑
왕협청%전소운%왕효휘%왕전%방백량
儿童加强监护病房%住院时间%原因%预后
兒童加彊鑑護病房%住院時間%原因%預後
인동가강감호병방%주원시간%원인%예후
Pediatric intensive care unit%Length of hospital%Reason%Prognosis
目的：分析PICU患儿长时间住院的原因,探讨如何缩短PICU住院时间,提高医疗资源利用效率,并随访了解PICU长期住院患儿的远期预后。方法回顾性分析我院2013年1月至2014年7月PICU住院时间超过30 d患儿的基本信息,包括入院时危重病例评分、原发病、出院转归等；分析滞留PICU的主要原因；应用儿童整体表现分类量表对本组患儿进行随访。采用SPSS 19.0统计软件包进行数据分析。结果纳入病例67例,男43例、女24例,年龄[中位数(四分位数间距)]24个月(8,108)。49.2%的患儿来源于急诊。住院天数[中位数(四分位数间距)]39 d(31,49)。入院时危重病例评分(78.39±9.57)分。住院费用(144071.74±76944.74)元。无任何医疗保险患儿30例(占44.8%)。原发病按系统疾病区分排在前三位的是：呼吸系统疾病30例,神经系统疾病8例,全身感染性疾病6例。基础疾病排在前三位的是：气管狭窄或支气管肺发育不良6例,先天性心脏病5例,免疫功能缺陷4例。并发症排在前三位的是：呼吸衰竭30例,多脏器功能不全或衰竭16例,休克9例。不能离开PICU的原因前三位依次是撤离呼吸机困难29例,转科或转院困难20例,喂养困难16例。好转出院54例,自动出院10例,出院时、出院1个月、出院3个月、出院6个月累积病死率分别为4.5%、20.9%、25.4%、25.4%。随访至出院6个月,儿童整体表现分类量表评分良好及轻度异常(1~2分)共36例(53.7%)。结论采用无创通气序贯治疗,适时气管切开；打开ICU患儿出口,加强科室间协调；开辟多途径家庭病床和康复病房协助长期机械通气或撤机治疗；选择恰当的营养支持途径；经常组织疑难病症会诊；减少院内感染和并发症等,将有助于缩短患儿在PICU滞留时间。出院后存活大于3个月的患儿远期预后相对乐观。
目的：分析PICU患兒長時間住院的原因,探討如何縮短PICU住院時間,提高醫療資源利用效率,併隨訪瞭解PICU長期住院患兒的遠期預後。方法迴顧性分析我院2013年1月至2014年7月PICU住院時間超過30 d患兒的基本信息,包括入院時危重病例評分、原髮病、齣院轉歸等；分析滯留PICU的主要原因；應用兒童整體錶現分類量錶對本組患兒進行隨訪。採用SPSS 19.0統計軟件包進行數據分析。結果納入病例67例,男43例、女24例,年齡[中位數(四分位數間距)]24箇月(8,108)。49.2%的患兒來源于急診。住院天數[中位數(四分位數間距)]39 d(31,49)。入院時危重病例評分(78.39±9.57)分。住院費用(144071.74±76944.74)元。無任何醫療保險患兒30例(佔44.8%)。原髮病按繫統疾病區分排在前三位的是：呼吸繫統疾病30例,神經繫統疾病8例,全身感染性疾病6例。基礎疾病排在前三位的是：氣管狹窄或支氣管肺髮育不良6例,先天性心髒病5例,免疫功能缺陷4例。併髮癥排在前三位的是：呼吸衰竭30例,多髒器功能不全或衰竭16例,休剋9例。不能離開PICU的原因前三位依次是撤離呼吸機睏難29例,轉科或轉院睏難20例,餵養睏難16例。好轉齣院54例,自動齣院10例,齣院時、齣院1箇月、齣院3箇月、齣院6箇月纍積病死率分彆為4.5%、20.9%、25.4%、25.4%。隨訪至齣院6箇月,兒童整體錶現分類量錶評分良好及輕度異常(1~2分)共36例(53.7%)。結論採用無創通氣序貫治療,適時氣管切開；打開ICU患兒齣口,加彊科室間協調；開闢多途徑傢庭病床和康複病房協助長期機械通氣或撤機治療；選擇恰噹的營養支持途徑；經常組織疑難病癥會診；減少院內感染和併髮癥等,將有助于縮短患兒在PICU滯留時間。齣院後存活大于3箇月的患兒遠期預後相對樂觀。
목적：분석PICU환인장시간주원적원인,탐토여하축단PICU주원시간,제고의료자원이용효솔,병수방료해PICU장기주원환인적원기예후。방법회고성분석아원2013년1월지2014년7월PICU주원시간초과30 d환인적기본신식,포괄입원시위중병례평분、원발병、출원전귀등；분석체류PICU적주요원인；응용인동정체표현분류량표대본조환인진행수방。채용SPSS 19.0통계연건포진행수거분석。결과납입병례67례,남43례、녀24례,년령[중위수(사분위수간거)]24개월(8,108)。49.2%적환인래원우급진。주원천수[중위수(사분위수간거)]39 d(31,49)。입원시위중병례평분(78.39±9.57)분。주원비용(144071.74±76944.74)원。무임하의료보험환인30례(점44.8%)。원발병안계통질병구분배재전삼위적시：호흡계통질병30례,신경계통질병8례,전신감염성질병6례。기출질병배재전삼위적시：기관협착혹지기관폐발육불량6례,선천성심장병5례,면역공능결함4례。병발증배재전삼위적시：호흡쇠갈30례,다장기공능불전혹쇠갈16례,휴극9례。불능리개PICU적원인전삼위의차시철리호흡궤곤난29례,전과혹전원곤난20례,위양곤난16례。호전출원54례,자동출원10례,출원시、출원1개월、출원3개월、출원6개월루적병사솔분별위4.5%、20.9%、25.4%、25.4%。수방지출원6개월,인동정체표현분류량표평분량호급경도이상(1~2분)공36례(53.7%)。결론채용무창통기서관치료,괄시기관절개；타개ICU환인출구,가강과실간협조；개벽다도경가정병상화강복병방협조장기궤계통기혹철궤치료；선택흡당적영양지지도경；경상조직의난병증회진；감소원내감염화병발증등,장유조우축단환인재PICU체류시간。출원후존활대우3개월적환인원기예후상대악관。
Objective To analyse the reasons for patients′long PICU stay and to discuss how to de-crease their PICU stay length and optimize medical resource utilization.The another objective is to identify these patients′long-term outcome.Methods We retrospectively analysed the basic information of patients who stayed in our PICU more than 30 days during January 1,2013 to July 31,2014,including pediatric criti-cal illness score on admission,primary diseases and outcome on discharge,in order to determine main reasons for their long PICU stay.Follow-up prognosis was made by Paediatric Overall Performance Category.We used SPSS 19.0 to do data analysis.Results Sixty-seven patients enrolled in this study included 43 boys and 24 girls,49.2%of whom came from emergency department.The median age was 24 months(IQR 8,108), while median length of PICU stay was 39 days(IQR 31,49).Mean pediatric critical illness score on admi-ssion was 78.39 ±9.57.Mean hospital fees was(144 071.74 ±76 944.74)Yuan.Thirty(44.8%)patients did not have any medical insurance.Top three primary diseases were respiratory disease(30 cases),neurolog-ical disease(8 cases)and systemic infection(6 cases).Top three underlying diseases were tracheostenosis or bronchopulmonary dysplasia(6 cases),congenital heart disease(5 cases)and immunodeficiencies(4 cases). Top three complications were respiratory failure(30 cases),multiple organ dysfunction or failure(16 cases), shock(9 cases).Top three reasons for longer PICU stay were weaning off mechanical ventilation difficulty (29 cases),department or hospital transference difficulty(20 cases),feeding difficulty(16 cases).Fifty-four patients were discharged with better health condition,10 patients were auto-discharge.The mortality at dis-charge,1 month after discharge,3 months after discharge and 6 months after discharge were 4.5%,20.9%, 25.4% and 25.4%,respectively.Total 36(53.7%)patients had a good or mildly abnormal Paediatric Over-all Performame Category score(1-2 points)at 6 months after discharge.Conclusion Sequential noninvasive ventilation,timely tracheotomy,timely patients′transference to general ward,development of family ward and rehabilitation wards,appropriate nutrition delivery,regularly difficult disease consultation,reduction of hospi-tal infection and complications may do contribution to shorten these patients′length of PICU stay.Children who survive longer than 3 months after discharge have better long-term prognosis.
