摘要
目的调查我国儿科重症监护病房(PICU)急性呼吸窘迫综合征(ARDS)的患病率、原发病、病死率及其影响因素。方法应用小儿危重病例评分和美国PICU入出院指南对2004年1月1日至2004年12月31日期间国内25家儿童医院及某些三级甲等医院的PICU中29d至14周岁院患儿进行危重病例筛选;应用1994年美欧标准对ARDS病例进行诊断。结果此次研究共有危重病例6839例,其中ARDS97例,病死61例,患病率1.42%,病死率、24h及24h后病死率分别为62.9%、23.7%、51.4%;占同期PICU病死率的13.1%,死亡相对危险性是PICU平均水平的9.3倍。肺炎(54.6%)、败血症(22.7%)为ARDS最常见的原发病。小于1岁起病者40例(41.2%),显著高于其他年龄段(P<0.01),ARDS起病距原发病出现时间为(75.6±53.0)h,其第25、50、75、90、95百分位分别为24、72、120、144、168h。起病距入PICU时间小于24h者59例,占60.8%。ARDS存活者人均住院费用为危重病例的4.5倍。结论小儿ARDS是PICU中的低患病率、高病死率、高疾病负担的危重症,起病原因多为肺炎和败血症。确诊24h内的ICU救治是提高ARDS存活率的关键之一。
Objective To investigate incidence,primary disease, mortality and influencing factors in children with acute respiratory distress syndrome (ARDS) in pediatric intensive care units (PICU). Methods From January 1 to December 31, 2004, we prospectively surveyed all children with 29 days to 14 years old admitted to 25 PICU in China.Chinese pediatric critical care scoring system and American guidelines for admission and discharge policies for PICU were applied. ARDS was diagnosed according to the 1994 American- European Consensus Conference criteria.Results A total of 6 839 children were enrolled, and 97 (1.42%) developed ARDS. Mortality in these ICUs was 6.8% (464/6 839), and overall mortality for ARDS was 62.9% (61/97), accounting for 13.1% of ICU deaths (61/464) which was approximately 9 times as high as the relative risk factor of PICU death rate. Major primary disease for ARDS were pneumonia (54.6%) and sepsis (22.7%). The median age at onset of ARDS was (53.1±54.2) months, with 41.2% less than 12 months of age. The time course between onset of the primary disease and onset of ARDS was (75.6±53.0) hours, the 25^(th), 50^(th), 75^(th), 90^(th), 95^(th) percentile were 24, 72, 120, 144, 168 hours,respectively. The median time from admission to PICU to the onset of ARDS was 16.5 h (ranging 0～1 224 h), with 60.8% < 24 h. Costs of clinical care for ARDS survivors were 4.5 times as high as those for general PICU stay. Conclusion Although it is an unusual problem in PICU, ARDS has a mortality and costs. Improved clinical management,including standardized respiratory therapy,is required for pediatric ARDS, and the first 24-hour period of the onset tends to be the most critical for survival. It warrants multicenter clinical trial using effective lung protection strategy to combat pediatric ARDS.
出处
《中华急诊医学杂志》
CAS
CSCD
2005年第6期448-453,共6页
Chinese Journal of Emergency Medicine
基金
上海市教委曙光跟踪计划(02GZ02)
美国中华医学基金会资助项目(03-786)
