儿童急性呼吸窘迫综合征34例临床分析

发布时间：2018-02-24 14:36

本文关键词： 急性呼吸窘迫综合征儿童临床分析　出处：《广西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨儿童急性呼吸窘迫综合征（ARDS）的致病及影响预后的危险因素、诊断及治疗，为临床早期识别、合理治疗提供理论参考。方法：选择2010年1月至2012年12月广西医科大学第一附属医院PICU病房住院诊断为急性呼吸窘迫综合征的儿童（新生儿除外）病例资料进行回顾性分析,并根据脓毒症诊断标准将病例分为脓毒症组和非脓毒症组。结果：1.诊断为ARDS患儿共34例，占同期患儿住院构成比2%；病死数20例（包括放弃治疗自动出院后死亡7例），病死率58.8%；内科疾病起源病例数30例（88.2%），外科疾病起源病例数4例（11.7%）；接受机械通气28例（93.3%）,其中机械通气大于72小时23例（76%）。 2.肺炎（无并发脓毒症）12例（35.2%），为首要原发病，肺炎合并脓毒症11例（32.3%)，为次要原发病。 3.对全部患儿机械通气前、机械通气后8小时、24小时、48小时、72小时的血气分析进行分析比较，非脓毒症组患儿经过呼吸机辅助通气后72小时，PaO2和PaCO2得到显著改善，PH、PaO2/FiO2无明显改善；脓毒症组患儿通气后PH、PaO2、PaCO2、PaO2/FiO2均有显著改善。 4.起病距原发病时间均值70.6±44.3小时（中位数72小时）。与非脓毒症组比较,脓毒症组患儿起病距离原发病时间更短（t=2.137，P=0.046）。 5.接受机械通气的患儿潮气量均值5.7±3.5ml/kg，符合小潮气量通气范围；脓毒症组与非脓毒症组患儿机械通气参数无显著差异；1例患儿通气后发生纵隔、皮下气肿，呼吸机相关性肺损伤发生率2.9%。 6.本研究患儿ARDS最重要的致病因素为肺炎；单因素、多因素logistic回归模型分析结果表明,本研究患儿疾病起源、基础疾病、肺炎与ARDS预后显著相关。结论：1.儿童ARDS仍为高死亡率疾病；2.肺炎是儿童ARDS最重要的致病因素；3.保护性通气是治疗ARDS的重要策略
[Abstract]:Objective: to investigate the risk factors, diagnosis and treatment of acute respiratory distress syndrome (ARDS) in children. Methods: the data of children (except newborns) with acute respiratory distress syndrome (ARDS) in PICU ward of the first affiliated Hospital of Guangxi Medical University from January 2010 to December 2012 were retrospectively analyzed. The patients were divided into sepsis group and non-sepsis group according to the diagnostic criteria of sepsis. Results 1. 34 cases of ARDS were diagnosed. In the same period, 20 cases died (including 7 cases of death after automatic discharge from hospital, 58.8% of mortality), 30 cases of the origin of internal diseases, 4 cases of surgical diseases, 4 cases of surgical diseases, 28 cases of mechanical ventilation. Mechanical ventilation was more than 72 hours in 23 cases. 2. Pneumonia (12 cases without sepsis) was the primary primary disease, and 11 cases with pneumonia with sepsis were 32. 3%, which were secondary primary diseases. 3.The blood gas analysis of all the children before mechanical ventilation and after 8 hours 24 hours and 48 hours and 72 hours after mechanical ventilation showed that PaO2 and PaCO2 were significantly improved 72 hours after ventilator assisted ventilation in non-sepsis group. No significant improvement was found in PHPao _ 2 / FiO _ 2; In sepsis group, the Pao _ 2 / FiO _ 2 / FiO _ 2 ratio of Paco _ 2 and Paco _ 2 / FiO _ 2 were significantly improved after ventilation. 4. The mean time from onset to primary disease was 70.6 卤44.3 hours (median 72 hours). Compared with non-sepsis group, the onset time of sepsis group was much shorter than that of non-sepsis group. 5. The mean tidal volume of children undergoing mechanical ventilation was 5.7 卤3.5 ml / kg, which was in accordance with the range of low tidal volume ventilation, and there was no significant difference in mechanical ventilation parameters between sepsis group and non-sepsis group. One case developed mediastinum and subcutaneous emphysema after ventilation. The incidence of ventilator-associated lung injury was 2.9%. 6. The most important pathogenic factor of ARDS in this study was pneumonia, and the results of univariate and multivariate logistic regression analysis showed that the origin of disease, the underlying disease, pneumonia and prognosis of ARDS were significantly correlated in this study. Conclusion ARDS is still a high mortality disease in children 2.pneumonia is the most important pathogenic factor of ARDS in children 3.Protective ventilation is an important strategy in the treatment of ARDS.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.6

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