Gavin R, Anderson B, Percival T
Auckland Children's Hospital.
N Z Med J. 1996 Apr 26;109(1020):137-9.
Bronchiolitis is a common respiratory illness in children. We reviewed our experience of children under one year presenting to an intensive care unit with a clinical diagnosis of bronchiolitis in order to determine if ethnicity, prematurity, arterial carbon dioxide tension or nasopharyngeal aspirates positive for respiratory syncytial virus were related to the need for ventilator assistance.
A review of the charts of all infants with bronchiolitis admitted to the paediatric intensive care unit from December 1991 to February 1994 was undertaken.
There were 94 infants. Ventilator assistance was given to 24 children--nine children had nasopharyngeal continuous positive airway pressure and 15 children required intermittent positive pressure ventilation. There was no difference in ethnic mix between the respiratory support group (Maori 45%, Pacific Islands 30%, other 25%) and those children managed conservatively (Maori 40%, Pacific Islands 36%, other 24%). Fifteen of the 24 infants who needed ventilator support were born prematurely. The mean (corrected) age of infants who required respiratory support was 1.79 (SD2.98) months compared to 3.32 (SD2.58) months for those infants who did not (p < 0.01). We were able to match 19 of the 24 infants who required ventilator support by age, sex and ethnicity with a nonventilated child. There was no significant difference in admission PaCO2 between groups (7.7 SD 1.5 vs 8.1 SD 1.5 kPa) or highest PaCO2 in the first 24 hours for nonventilated children and preintubation PaCO2 in ventilated children (8.6 SD1.3 vs 8.9 SD 1.9kPa). Nasopharyngeal aspirates were positive for respiratory syncytial virus in 39 patients. Respiratory support was required for 13 children who had positive RSV aspirates and for nine children who were not RSV positive (NS).
Infants with bronchiolitis that were premature were not likely to need respiratory support. Ethnicity, arterial PaCO2 and positivity for RSV were not related to the need for ventilator assistance.
细支气管炎是儿童常见的呼吸道疾病。我们回顾了1岁以下因临床诊断为细支气管炎而入住重症监护病房的儿童的情况，以确定种族、早产、动脉血二氧化碳分压或呼吸道合胞病毒鼻咽抽吸物呈阳性是否与需要呼吸机辅助有关。
对1991年12月至1994年2月入住儿科重症监护病房的所有细支气管炎婴儿的病历进行了回顾。
共有94名婴儿。24名儿童接受了呼吸机辅助——9名儿童采用鼻咽持续气道正压通气，15名儿童需要间歇正压通气。接受呼吸支持的组（毛利人45%，太平洋岛屿居民30%，其他25%）与保守治疗的儿童（毛利人40%，太平洋岛屿居民36%，其他24%）在种族构成上没有差异。24名需要呼吸机支持的婴儿中有15名早产。需要呼吸支持的婴儿的平均（校正）年龄为1.79（标准差2.98）个月，而不需要呼吸支持的婴儿为3.32（标准差2.58）个月（p<0.01）。我们能够将24名需要呼吸机支持的婴儿中的19名按年龄、性别和种族与一名未使用呼吸机的儿童进行匹配。两组之间入院时的动脉血二氧化碳分压（7.7±1.5与8.1±1.5kPa）或未使用呼吸机儿童在最初24小时内的最高动脉血二氧化碳分压与使用呼吸机儿童插管前的动脉血二氧化碳分压（8.6±1.3与8.9±1.9kPa）没有显著差异。39例患者的鼻咽抽吸物呼吸道合胞病毒呈阳性。13例呼吸道合胞病毒抽吸物呈阳性的儿童和9例呼吸道合胞病毒呈阴性的儿童需要呼吸支持（无显著性差异）。
早产的细支气管炎婴儿不太可能需要呼吸支持。种族、动脉血二氧化碳分压和呼吸道合胞病毒阳性与是否需要呼吸机辅助无关。
