Zhang H L, Feng Z C, Cheng Y, Zhao Z, Chen Y F, Liu C J, Cheng D L, Shi C S, Wang F, Wang J, Jin Y P, Yin Y, Lu G P, Hong X Y
The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China.
Pediatric Intensive Care Unit, Department of Pediatrics, People's Liberation Army General Hospital, the Second School of Clinical Medicine, Southern Medical University, Beijing 100700, China.
Zhonghua Er Ke Za Zhi. 2021 May 2;59(5):380-386. doi: 10.3760/cma.j.cn112140-20210222-00148.
To explore the risk factors for mortality in pediatric acute respiratory distress syndrome (PARDS) requiring extracorporeal membrane oxygenation (ECMO) support. Clinical data of 109 patients with severe PARDS supported by ECMO, who were hospitalized in 6 ECMO centers in China from September 2012 to February 2020, were retrospectively analyzed. They were divided into survival group and death group according to the prognosis. Chi-square test and rank sum test were used to compare the variables between the two groups, including the demographic data, laboratory examination results, clinical data before and after ECMO, and other supportive treatment. Univariate and multivariate Logistic regression models were used to analyze the prognostic risk factors. In these 109 cases, 54 died and 55 survived. Compared with the survival group, the death group had higher incidences of acute kidney injury (AKI) (48.1% (26/54) . 21.8% (12/55) χ²=8.318, =0.004) and coagulation dysfunction (22.2% (12/54) 7.3% (4/55) χ²=4.862, =0.027), and higher rate of renal replacement therapy (48.1% (26/54) 21.8% (12/55) χ²=9.694, =0.008) during ECMO support. Logistic regression analysis showed that continuous renal replacement therapy (CRRT) and AKI were independent risk factors for death in patients with severe PARDS requiring ECMO support (=3.88,95% 1.04-14.52, =4.84,95% 1.21-19.46, both 0.05). AKI and CRRT are independent risk factors for predicting mortality in patients with severe PARDS requiring ECMO support.
探讨需要体外膜肺氧合（ECMO）支持的小儿急性呼吸窘迫综合征（PARDS）患者的死亡危险因素。回顾性分析了2012年9月至2020年2月在中国6个ECMO中心住院的109例接受ECMO支持的重度PARDS患者的临床资料。根据预后将他们分为生存组和死亡组。采用卡方检验和秩和检验比较两组之间的变量，包括人口统计学数据、实验室检查结果、ECMO前后的临床资料以及其他支持治疗。采用单因素和多因素Logistic回归模型分析预后危险因素。在这109例患者中，54例死亡，55例存活。与生存组相比，死亡组急性肾损伤（AKI）的发生率更高（48.1%（26/54）对21.8%（12/55），χ²=8.318，P=0.004）和凝血功能障碍的发生率更高（22.2%（12/54）对7.3%（4/55），χ²=4.862，P=0.027），且在ECMO支持期间肾脏替代治疗的比例更高（48.1%（26/54）对21.8%（12/55），χ²=9.694，P=0.008）。Logistic回归分析显示，连续性肾脏替代治疗（CRRT）和AKI是需要ECMO支持的重度PARDS患者死亡的独立危险因素（P=3.88，95%CI 1.04-14.52，P=4.84，95%CI 1.21-19.46，均P<0.05）。AKI和CRRT是预测需要ECMO支持的重度PARDS患者死亡率的独立危险因素。
