急性呼吸窘迫综合征后儿童的长期肺功能和生活质量：一项可行性调查。
Long-Term Pulmonary Function and Quality of Life in Children After Acute Respiratory Distress Syndrome: A Feasibility Investigation.
作者信息
Ward Shan L, Turpin Autumn, Spicer Aaron C, Treadwell Marsha J, Church Gwynne D, Flori Heidi R
机构信息
1Division of Pediatric Critical Care, Department of Pediatrics, UCSF Benioff Children's Hospitals, San Francisco and Oakland, CA.2Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.3Department of Hematology/Oncology, UCSF Benioff Children's Hospital, Oakland, CA.4Division of Pediatric Pulmonology, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA.5Division of Pediatric Critical Care, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI.
出版信息
Pediatr Crit Care Med. 2017 Jan;18(1):e48-e55. doi: 10.1097/PCC.0000000000001014.
OBJECTIVES
To determine the feasibility of pulmonary function and quality of life evaluations in children after acute respiratory distress syndrome.
DESIGN
A prospective follow-up feasibility study.
SETTING
A tertiary PICU.
PATIENTS
Children less than 18 years old with acute respiratory distress syndrome admitted between 2000 and 2005.
INTERVENTION
Pulmonary function testing and patient and parental quality of life surveys approximately 12-month after acute respiratory distress syndrome.
MEASUREMENTS AND MAIN RESULTS
One hundred eighty patients met acute respiratory distress syndrome criteria; 37 (20%) died, 90 (51%) declined participation, 28 (16%) consented but did not return, and 24 (13%) returned for follow-up visit. Twenty-three patients completed quality of life testing and 17 completed pulmonary functions. Clinical characteristics of those who returned were no different from those who did not except for age (median age, 4.9 vs 1.8 yr). One-third had mild to moderate pulmonary function deficits. Quality of life scores were marginal with general health perception, physical functioning, and behavior being areas of concern. These scores were lower than scores in children with chronic asthma. Parental quality of life assessments report lower scores in single-parent homes but no differences were noted by race or parental employment status.
CONCLUSIONS
Valuable information may be discerned from acute respiratory distress syndrome patients who return for follow-up evaluation. In this pilot study, up to one-third of children with acute respiratory distress syndrome exhibit pulmonary function deficits and 12-month postillness quality of life scores are lower than in children with chronic asthma. Parental perceptions of postillness quality of life may be negatively impacted by socioeconomic constraints. Long-term follow of children with acute respiratory distress syndrome is feasible and bears further investigation.
目的
确定对急性呼吸窘迫综合征患儿进行肺功能和生活质量评估的可行性。
设计
一项前瞻性随访可行性研究。
地点
一家三级儿科重症监护病房。
患者
2000年至2005年间收治的18岁以下急性呼吸窘迫综合征患儿。
干预措施
在急性呼吸窘迫综合征发生约12个月后进行肺功能测试以及患者和家长生活质量调查。
测量指标及主要结果
180名患者符合急性呼吸窘迫综合征标准；37名（20%）死亡，90名（51%）拒绝参与，28名（16%）同意但未返回，24名（13%）返回接受随访。23名患者完成了生活质量测试，17名完成了肺功能测试。返回接受随访的患者的临床特征与未返回者相比，除年龄外（中位年龄，4.9岁对1.8岁）无差异。三分之一的患者有轻度至中度肺功能缺陷。生活质量评分在总体健康感知、身体功能和行为方面令人担忧，处于边缘水平。这些评分低于慢性哮喘患儿的评分。家长对生活质量的评估报告显示，单亲家庭的评分较低，但在种族或家长就业状况方面未发现差异。
结论
对返回接受随访评估的急性呼吸窘迫综合征患者可以获取有价值的信息。在这项初步研究中，高达三分之一的急性呼吸窘迫综合征患儿存在肺功能缺陷，患病12个月后的生活质量评分低于慢性哮喘患儿。社会经济限制可能会对家长对患病后生活质量的认知产生负面影响。对急性呼吸窘迫综合征患儿进行长期随访是可行的，值得进一步研究。
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