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目的调查我国儿科重症监护病房中小儿急性呼吸窘迫综合征的病死率及死亡危险因素。方法应用小儿危重病例评分和美国儿科重症监护病房(PICU)入出院指南对2004年1月1日至2004年12月31日25家 PICU 29 d～14周岁院患儿进行危重病例筛选;应用1994年美欧标准对住院患者中的急性呼吸窘迫综合征(ARDS)病例进行诊断。结果危重病例7269例,ARDS 105例,病死64例,患病率1.44%,病死率、24 h 病死率分别为62.9%、35.9%。死亡相对危险性是 PICU平均水平的9.0倍。Logistic 模型分析示起病时胸片浸润影、小儿危重病例评分及动脉血二氧化分压(PaCO_2)可作为 ARDS 病死的独立相关因素(P 值分别为0.004,0.001,0.030)。结论小儿 ARDS是我国 PICU 中具有高病死率的危重症,起病时的胸片浸润影、小儿危重病例评分、PaCO_2是其主要死亡危险因素。
Objective To investigate the mortality and risk factors of childhood acute respiratory distress syndrome in pediatric intensive care unit in China. Methods The critically ill cases were selected from 25 PICU children aged 29 to 14 years from January 1, 2004 to December 31, 2004 using the pediatric critical illness score and the American pediatric intensive care unit (PICU) American and European standards for the diagnosis of acute respiratory distress syndrome (ARDS) in hospitalized patients. Results 7269 critically ill patients, ARDS 105 cases, died of 64 cases, the prevalence of 1.44%, mortality, 24 h mortality were 62.9%, 35.9%. The relative risk of death is 9.0 times the PICU average. Logistic model analysis showed that chest wall infiltrates, pediatric critical illness and PaCO_2 were independent risk factors for ARDS (P = 0.004, 0.001, 0.030, respectively). Conclusion Pediatric ARDS is a critical illness with high mortality in PICU. The chest X-ray infiltration at onset, the critical case score in children and PaCO_2 are the major risk factors for death.