Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
Pediatr Pulmonol. 2013 Apr;48(4):390-7. doi: 10.1002/ppul.22608. Epub 2012 Jul 6.
Pneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with severe CAP need to be determined to optimize care.
To prospectively determine PICU CAP admission features and outcomes.
A 4 year prospective study of CAP aged 1 month to <14 years admitted to PICU, Children's Hospital Affiliated to Soochow University, China. All were managed in a standard manner. Clinical, laboratory, and imaging findings were collected systematically. All received antibiotics.
Eight hundred ten (7%) of 10,836 CAP hospital admissions needed PICU. Seven hundred seven (87%) were enrolled. PICU CAP children were young (76% ≤ 12 months) and 33% had co-morbid conditions; 21% congenital heart disease.21% required mechanical ventilation. The average length of PICU stay was 5 days (range, 3-27). The case fatality rate was 5.8%. Viruses were detected in 38%, RSV 24%; bacteria in 23%, Streptococcus pneumoniae 7%, Haemophilus influenza b 4%, Mycoplasma 11%. On single factor analysis, PICU admission respiratory rate >70/min, grunting/groaning, head nodding, cyanosis, and anemia were associated with respiratory failure and with fatality. On multivariate analysis only presence of congenital heart disease, Trisomy 21 and immunodeficiency correlated with fatality; not microbe nor PICU findings.
Young age and underlying congenital heart disease were associated factors for PICU support in CAP in China. Early referral if altered sensorium, high respiratory rate, head nodding, grunting and anemia, and universal access to conjugated vaccines may decrease morbidity and mortality.
肺炎是 5 岁以下儿童死亡的主要原因。中国 CAP 患儿数量居高不下，儿童重症监护病房（PICU）的可及性不断提高，因此需要确定与严重 CAP 相关的因素，以优化治疗。
前瞻性确定 PICU 中 CAP 患儿的入院特征和结局。
这是一项在中国苏州大学附属儿童医院进行的为期 4 年的 CAP 患儿前瞻性研究，纳入年龄在 1 个月至 14 岁之间、需要入住 PICU 的患儿。所有患儿均采用标准方式进行管理。系统收集临床、实验室和影像学资料。所有患儿均接受抗生素治疗。
在 10836 例 CAP 住院患儿中，有 710 例（7%）需要入住 PICU，其中 707 例（87%）患儿入组。PICU 中 CAP 患儿年龄较小（76%≤12 个月），33%合并基础疾病，21%存在先天性心脏病，21%需要机械通气。PICU 住院时间平均为 5 天（范围：3-27 天），病死率为 5.8%。38%的患儿病毒检测阳性，其中呼吸道合胞病毒占 24%；23%的患儿细菌检测阳性，肺炎链球菌占 7%，流感嗜血杆菌占 4%，支原体占 11%。单因素分析显示，PICU 入院时呼吸频率＞70 次/分、喘鸣、点头呼吸、发绀和贫血与呼吸衰竭和死亡相关。多因素分析显示，仅存在先天性心脏病、21 三体和免疫缺陷与病死率相关，而与微生物或 PICU 检查结果无关。
在中国，CAP 患儿入住 PICU 的相关因素为年龄较小和存在基础先天性心脏病。如果出现意识改变、呼吸频率增快、点头呼吸、喘鸣和贫血，应尽早转至 PICU，并普遍使用结合疫苗，可能会降低发病率和死亡率。
