小儿急性低氧性呼吸衰竭呼吸支持相关预后差异及影响因素

摘要

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.%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.