影响PICU机械通气患儿预后的相关因素分析

发布时间：2018-04-25 19:56

本文选题：儿童重症监护室 + 机械通气　；参考：《安徽医科大学》2015年硕士论文

【摘要】：目的探讨影响我院P I C U(儿科重症监护室)内行机械通气患儿预后的有关因素,为临床识别危重症及更好诊治提供帮助,降低本地区机械通气危重症患儿的病死率及致残率。方法回顾性分析2011年1月至2014年12月入住我院儿科重症监护室64例行机械通气的危重症患儿的临床资料,采用SPSS17.0软件包对可能影响预后的24个单因素进行单因素分析,对满足正态分布的条件的定量资料以均数±标准差(M±SD)描述,组间比较采用独立t检验;对不符合正态分布的定量资料用中位数及四分位间距M(QU-QL)描述,组间比较采用秩和检验;率或构成比的差异性对比采用X2检验,以p0.05表明有统计学差异。再将有统计学意义的单因素纳入二分类Logistics回归模型,以p0.05为有统计学意义。结果24个单因素进行单因素分析后发现行机械通气危重儿的性别、年龄、是否感染性疾病、白细胞计数、部分凝血酶活化时间、谷丙转氨酶、肌酸激酶同工酶、血K+、血Na+、PH值、氧分压、二氧化碳分压、血小板计数、血肌酐、血小板压积、平均血小板体积、血糖水平并不影响机械通气危重患儿的预后,小儿危重症评分、血清白蛋白水平、乳酸脱氢酶水平、血钙、住院时间、降钙素原、机械通气时间这7个因素对PICU机械通气患儿预后有影响,多因素的逐步回归分析表明小儿危重症评分、血清白蛋白水平、乳酸脱氢酶、血钙、住院时间为影响危重症患儿预后的独立危险因素。结论小儿危重症评分、血清白蛋白水平、乳酸脱氢酶、血钙可以作为评价儿内科重症监护病房行机械通气患儿预后的一个参考指标,住院时间为预后的有利因素。降钙素原对儿内科行机械通气患儿预后有一定影响。在PICU机械通气患儿治疗过程中,临床医师应该高度注意这些可能导致机械通气患儿治疗失败的不利因素,早期制定相关防治方案,最大程度上改善机械通气危重症患儿的预后,降低危重症患儿的死亡率。
[Abstract]:Objective to explore the factors influencing the prognosis of children with mechanical ventilation in P I C U( pediatric intensive care unit, to provide help for clinical identification and better diagnosis and treatment, and to reduce the mortality and disability rate of children with mechanical ventilation in this area. Methods the clinical data of 64 critically ill children admitted to pediatric intensive care unit from January 2011 to December 2014 were analyzed retrospectively. 24 univariate analysis was performed with SPSS17.0 software package. The quantitative data satisfying the condition of normal distribution were described by mean 卤standard deviation (M 卤SD), and the comparison between groups was performed by independent t test, and the quantitative data which did not conform to normal distribution were described by median and quartile spacing (MNQU-QL), and rank sum test was used in the comparison between groups. The difference of rate or composition ratio was compared by X 2 test, p 0.05 indicated that there was statistical difference. Then the single factor with statistical significance was incorporated into the two-classification Logistics regression model, and p0. 05 was statistically significant. Results after univariate analysis, sex, age, infectious disease, white blood cell count, partial thrombin activation time, alanine aminotransferase, creatine kinase isoenzyme, blood K were found in 24 critically ill children undergoing mechanical ventilation. Blood Na PH, partial pressure of oxygen, partial pressure of carbon dioxide, platelet count, serum creatinine, platelet hematocrit, mean platelet volume, blood glucose level did not affect the prognosis of children with severe mechanical ventilation, critical grade of children, serum albumin level. The levels of lactate dehydrogenase, serum calcium, hospitalization time, procalcitonin and mechanical ventilation time had influence on the prognosis of children with PICU. The stepwise regression analysis of multiple factors showed that the critical disease score and serum albumin level were significantly increased in children with PICU. Lactate dehydrogenase, blood calcium and length of stay were independent risk factors for prognosis of critically ill children. Conclusion critical illness score, serum albumin level, lactate dehydrogenase and serum calcium can be used as a reference index to evaluate the prognosis of children undergoing mechanical ventilation in intensive care unit of pediatric medicine, and the hospital stay is a favorable factor for prognosis. Procalcitonin has a certain effect on prognosis of children undergoing mechanical ventilation. In the course of treatment of children with PICU mechanical ventilation, clinicians should pay close attention to the unfavorable factors that may lead to the failure of the treatment of children with mechanical ventilation, make relevant prevention and treatment plans early, and improve the prognosis of severe children with mechanical ventilation to the greatest extent. Reduce mortality in critically ill children.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R725.6

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