儿童弥漫性肺泡出血62例治疗及预后危险因素分析

发布时间：2018-01-28 09:33

本文关键词： 弥漫性肺泡出血治疗预后危险因素　出处：《临床儿科杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的探讨影响儿童弥漫性肺泡出血(DAH)预后的危险因素。方法回顾分析2006年1月至2016年1月收治的62例弥漫性肺泡出血患儿的临床资料。根据患儿基础疾病分为免疫性DAH及非免疫性DAH,探讨早期糖皮质激素治疗对两组DAH疗效的影响;根据患儿预后分为死亡组与生存组,分析影响DAH死亡的危险因素。结果 62例DAH患儿中,免疫性DAH 20例、非免疫性DAH 42例,共死亡30例,病死率48.4%。30例早期使用糖皮质激素的DAH患儿中,免疫性DAH 18例,病死率33.3%(6/18例);非免疫性DAH 12例,病死率41.7%(5/12例),两组病死率差异无统计学意义(P=0.712)。42例非免疫性DAH患儿中,使用糖皮质激素者病死率41.7%(5/12例),未使用糖皮质激素者病死率60.0%(18/30例),两组病死率差异无统计学意义(P=0.281)。Logistic多因素回归分析发现,小儿危重症评分是DAH死亡的独立危险因素(OR=1.15,95%CI:1.03~1.28),为弱相关。结论 DAH是危及儿童生命的临床急重症,小儿危重症评分越低,死亡危险性越高。
[Abstract]:Objective to investigate the effect of DAH on diffuse alveolar hemorrhage in children. Methods the clinical data of 62 children with diffuse alveolar hemorrhage from January 2006 to January 2016 were retrospectively analyzed. According to the underlying diseases of the children, they were divided into immune DAH and non immune. Sex DAH. To investigate the effect of early glucocorticoid therapy on DAH in two groups. According to the prognosis of the children, they were divided into death group and survival group, and the risk factors affecting the death of DAH were analyzed. Results in 62 cases of DAH, 20 cases of immunological DAH and 42 cases of non-immune DAH were found. There were 30 cases of death, the mortality rate was 48.4%. Among the 30 cases of DAH with early use of glucocorticoid, there were 18 cases of immunological DAH and 18 cases of mortality of 33.3%. There were 12 cases of non-immune DAH with a mortality of 41.7% or 5 / 12 cases. There was no significant difference in mortality between the two groups (P < 0. 712). The fatality rate of patients with glucocorticoid was 41.7 / 12, and that without glucocorticoid was 60.0 / 18 / 30). There was no significant difference in mortality between the two groups. Logistic multivariate regression analysis showed that the score of critical illness in children was an independent risk factor for the death of DAH. Conclusion DAH is a critical clinical disease that endangers the life of children. The lower the score of critical illness in children, the higher the risk of death.
【作者单位】：成都市第五人民医院;儿童发育疾病研究教育部重点实验室儿童发育重大疾病国家国际科技合作基地儿科学重庆市重点实验室;重庆医科大学附属儿童医院呼吸科;
【基金】：国家临床重点专科建设项目(No.2011-873)
【分类号】：R725.6
【正文快照】： 弥漫性肺泡出血(diffuse alveolar hemorrhage,DAH)是一种急性的危及生命的临床综合征,由于各种因素引起肺泡毛细血管基底膜破坏,导致终末细支气管远端肺泡内广泛出血,临床表现主要为咯血、贫血及进行性低氧血症,胸部影像学表现为无特异性的双肺弥漫性浸润影[1-5]。既往研究报

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