欢迎访问《中国循证儿科杂志》官方网站，今天是
English Version
中国循证儿科杂志

中国循证儿科杂志 ›› 2024, Vol. 19 ›› Issue (1): 19-23.DOI: 10.3969/j.issn.1673-5501.2024.01.004

• 论著 • 上一篇    下一篇

长期机械通气患儿的死亡影响因素分析

刘艳玲1,2　陈若男2　党红星2　许峰2   

  1. 1 华中科技大学同济医院儿科　武汉，430030；2 重庆医科大学附属儿童医院PICU，国家儿童健康与疾病临床研究中心，儿童发育与疾病教育部重点实验室，重庆市儿科学重点实验室　重庆，400014
  • 收稿日期:2023-11-12 修回日期:2024-01-20 出版日期:2024-02-25 发布日期:2024-02-25
  • 通讯作者: 党红星

Analysis of factors influencing mortality in children undergoing prolonged mechanical ventilation

LIU Yanling1,2, CHEN Ruonan2, DANG Hongxing2, XU Feng2   

  1. 1 Department of Pediatrics, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, China;2 Department of PICU, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Yuzhong District, Chongqing 400014, China
  • Received:2023-11-12 Revised:2024-01-20 Online:2024-02-25 Published:2024-02-25
  • Contact: DANG Hongxing

PDF

37

摘要： 背景 近年来PICU接受长期机械通气（PMV）的患儿数量迅速增长，但影响PMV患儿死亡的因素尚不清楚。 目的 分析PICU接受PMV患儿死亡的影响因素。 设计 回顾性队列研究。 方法 纳入2020年10月1日至 2021 年6月30日重庆医科大学附属儿童医院PICU中有创机械通气持续时间≥14 d且每天通气时间≥6 h的连续病例，以出院后1个月生存和死亡为结局，从病例中截取入PICU时、在PICU治疗和出院时的信息，采用Cox回归分析影响死亡的因素。 主要结局指标 影响PMV患儿死亡的因素。 结果 研究期间PICU共收治1 815例患儿，机械通气1 144例，符合本文纳入标准的PMV患儿 127例，出院后1个月随访时存活组99例、死亡组28例（22.0%）。选择了入PICU时信息、PICU治疗信息和出院信息中的10项变量构建多因素Cox比例风险模型，出院后1个月时死亡风险：病程中的PELOD2评分≥4分是＜4分的2.9倍（HR=2.893，95%CI：1.182~7.079），输血治疗是不输血治疗的2.8倍（HR=2.766，95%CI：1.012~7.558），血液净化治疗是未行血液净化治疗的3倍（HR=2.978，95%CI：1.108~8.006），机械通气时间≥30 d是＜30 d的3.1倍（HR=3062，95%CI：1.282~7.312），总住院时间≥35 d较＜35 d出院后1个月时的死亡风险降低了89%（HR=0.112，95%CI：0037~7.312）。 结论 PICU接受PMV患儿出院后1个月的病死率为22%，病程中的PELOD2评分≥4分、输血治疗、血液净化治疗、机械通气时间≥30 d可使出院后1个月时的死亡风险升高2倍左右，总住院时间≥35 d可降低出院后1个月时的死亡风险。

关键词: 儿科, 长期机械通气, 撤机, 预后

Abstract: Background The number of pediatric patients undergoing prolonged mechanical ventilation (PMV) in pediatric intensive care units (PICUs) has been rapidly increasing, but the factors influencing mortality among these patients remain unclear. Objective To analyze the factors affecting mortality in pediatric patients receiving PMV in PICUs. Design Retrospective cohort study. Methods This study included consecutive cases of invasive mechanical ventilation for ≥14 days with ≥6 hours of ventilation per day at the PICU of the Children's Hospital of Chongqing Medical University from October 1, 2020, to June 30, 2021. Patients were followed for one month after discharge with survival and mortality as outcomes. Data were collected at PICU admission, during PICU treatment, and at discharge. Cox regression analysis was used to explore factors influencing mortality. Main outcome measures Factors influencing mortality in children undergoing PMV. Results During the study period, 1 815 patients were admitted to the PICU with 1 144 requiring mechanical ventilation. One hundred and twenty-seven patients met the inclusion criteria for PMV, among which 99 survived and 28 (22.0%) died during the first month of discharge. A multivariable Cox proportional hazards model was constructed using 10 variables from information at PICU admission, during treatment, and at discharge. The results showed that for risk of death during the first month of discharge, a PELOD-2 score ≥4 during the course was associated with a 2.9-fold increased risk (HR=2.893, 95% CI: 1.182-7.079), blood transfusion therapy with a 2.8-fold increased risk (HR=2.766, 95% CI: 1.012-7.558), blood purification therapy with a 3-fold increased risk (HR=2.978, 95% CI: 1.108-8006), and mechanical ventilation duration ≥30 days with a 3.1-fold increased risk (HR=3.062, 95% CI: 1.282-7.312), while hospital stay length≥35 days was associated with an 89% reduction in the risk of death (HR=0.112, 95% CI: 0.037-7.312). Conclusion The mortality rate among children receiving PMV in the PICU was 22%. Factors such as a PELOD-2 score ≥4, blood transfusion, blood purification therapy, and mechanical ventilation duration ≥30 days were associated with approximately a threefold increase in the risk of death during the first month after discharge, while hospital stay length ≥35 days was associated with a decreased risk of death.

Key words: Peidatric, Prolonged mechanical ventilation, extubation, Prognosis