Proesmans M, Vreys M, Huenaerts E, Haest E, Coremans S, Vermeulen F, Feys H
Department of pediatric pulmonology, Katholieke Universiteit Leuven, Leuven, Belgium.
Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
Pediatr Pulmonol. 2015 Oct;50(10):1033-8. doi: 10.1002/ppul.23114. Epub 2014 Oct 18.
'Profound intellectual and multiple disability' (PIMD) is defined as a profound cognitive disability with severe sensory and motor impairments. The aim of this study was to evaluate the respiratory morbidity in children with PIMD and investigate possible risk factors.
In 10 specialized facilities for daily care of patients with PIMD, children underwent a standardized clinical assessment evaluating respiratory and motor function. Additional medical information was obtained.
One hundred and twenty seven children aged 2-21 years were tested (median age 12 years; IQR 8-16). 72% had epilepsy, 42% were gastrostomy fed. The median number of lower airway infection per years was four (IQR 1-4). While 68% of patient had no hospital admissions for respiratory disease, 12% of patients were admitted three times or more. Chronic antibiotic therapy was prescribed to nine patients (7%), and 19 patients (15%) were chronically treated with mucolytics, inhaled corticosteroids and/or bronchodilators. Chest physiotherapy was given daily to 26 patients (22%). Gastroesophageal reflux, swallowing problem and aspiration increased the risk for hospital admissions. Additionally risk factors were the severity of disability, axial hypotonia, presence of epilepsy, scoliosis, limited shoulder movement, paradoxical breathing and absence of a spontaneous cough reflex.
The overall respiratory morbidity in our sample of children with PIMD was lower than anticipated. While a subgroup of children are prone to recurrent severe airway problems, the majority of children did not experience severe airway infections.
“重度智力和多重残疾”（PIMD）被定义为伴有严重感觉和运动障碍的重度认知残疾。本研究的目的是评估PIMD儿童的呼吸道发病率，并调查可能的风险因素。
在10个PIMD患者的专业日常护理机构中，对儿童进行了评估呼吸和运动功能的标准化临床评估。还获取了其他医学信息。
对127名2至21岁的儿童进行了测试（中位年龄12岁；四分位间距8-16）。72%的儿童患有癫痫，42%通过胃造口喂养。每年下呼吸道感染的中位数为4次（四分位间距1-4）。虽然68%的患者没有因呼吸系统疾病住院，但12%的患者住院3次或更多次。9名患者（7%）接受了长期抗生素治疗，19名患者（15%）长期接受黏液溶解剂、吸入性糖皮质激素和/或支气管扩张剂治疗。26名患者（22%）每天接受胸部物理治疗。胃食管反流、吞咽问题和误吸增加了住院风险。此外，风险因素还包括残疾严重程度、轴向肌张力减退、癫痫的存在、脊柱侧弯、肩部活动受限、反常呼吸和无自发咳嗽反射。
我们样本中PIMD儿童的总体呼吸道发病率低于预期。虽然一小部分儿童容易反复出现严重气道问题，但大多数儿童没有经历严重的气道感染。
