本文選題：兒童重癥監(jiān)護(hù)室 + 機(jī)械通氣��； 參考：《安徽醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的探討影響我院P I C U(兒科重癥監(jiān)護(hù)室)內(nèi)行機(jī)械通氣患兒預(yù)后的有關(guān)因素,為臨床識(shí)別危重癥及更好診治提供幫助,降低本地區(qū)機(jī)械通氣危重癥患兒的病死率及致殘率。方法回顧性分析2011年1月至2014年12月入住我院兒科重癥監(jiān)護(hù)室64例行機(jī)械通氣的危重癥患兒的臨床資料,采用SPSS17.0軟件包對(duì)可能影響預(yù)后的24個(gè)單因素進(jìn)行單因素分析,對(duì)滿(mǎn)足正態(tài)分布的條件的定量資料以均數(shù)±標(biāo)準(zhǔn)差(M±SD)描述,組間比較采用獨(dú)立t檢驗(yàn);對(duì)不符合正態(tài)分布的定量資料用中位數(shù)及四分位間距M(QU-QL)描述,組間比較采用秩和檢驗(yàn);率或構(gòu)成比的差異性對(duì)比采用X2檢驗(yàn),以p0.05表明有統(tǒng)計(jì)學(xué)差異。再將有統(tǒng)計(jì)學(xué)意義的單因素納入二分類(lèi)Logistics回歸模型,以p0.05為有統(tǒng)計(jì)學(xué)意義。結(jié)果24個(gè)單因素進(jìn)行單因素分析后發(fā)現(xiàn)行機(jī)械通氣危重兒的性別、年齡、是否感染性疾病、白細(xì)胞計(jì)數(shù)、部分凝血酶活化時(shí)間、谷丙轉(zhuǎn)氨酶、肌酸激酶同工酶、血K+、血Na+、PH值、氧分壓、二氧化碳分壓、血小板計(jì)數(shù)、血肌酐、血小板壓積、平均血小板體積、血糖水平并不影響機(jī)械通氣危重患兒的預(yù)后,小兒危重癥評(píng)分、血清白蛋白水平、乳酸脫氫酶水平、血鈣、住院時(shí)間、降鈣素原、機(jī)械通氣時(shí)間這7個(gè)因素對(duì)PICU機(jī)械通氣患兒預(yù)后有影響,多因素的逐步回歸分析表明小兒危重癥評(píng)分、血清白蛋白水平、乳酸脫氫酶、血鈣、住院時(shí)間為影響危重癥患兒預(yù)后的獨(dú)立危險(xiǎn)因素。結(jié)論小兒危重癥評(píng)分、血清白蛋白水平、乳酸脫氫酶、血鈣可以作為評(píng)價(jià)兒內(nèi)科重癥監(jiān)護(hù)病房行機(jī)械通氣患兒預(yù)后的一個(gè)參考指標(biāo),住院時(shí)間為預(yù)后的有利因素。降鈣素原對(duì)兒內(nèi)科行機(jī)械通氣患兒預(yù)后有一定影響。在PICU機(jī)械通氣患兒治療過(guò)程中,臨床醫(yī)師應(yīng)該高度注意這些可能導(dǎo)致機(jī)械通氣患兒治療失敗的不利因素,早期制定相關(guān)防治方案,最大程度上改善機(jī)械通氣危重癥患兒的預(yù)后,降低危重癥患兒的死亡率。
[Abstract]:Objective to explore the factors influencing the prognosis of children with mechanical ventilation in P I C U( pediatric intensive care unit, to provide help for clinical identification and better diagnosis and treatment, and to reduce the mortality and disability rate of children with mechanical ventilation in this area. Methods the clinical data of 64 critically ill children admitted to pediatric intensive care unit from January 2011 to December 2014 were analyzed retrospectively. 24 univariate analysis was performed with SPSS17.0 software package. The quantitative data satisfying the condition of normal distribution were described by mean 鹵standard deviation (M 鹵SD), and the comparison between groups was performed by independent t test, and the quantitative data which did not conform to normal distribution were described by median and quartile spacing (MNQU-QL), and rank sum test was used in the comparison between groups. The difference of rate or composition ratio was compared by X 2 test, p 0.05 indicated that there was statistical difference. Then the single factor with statistical significance was incorporated into the two-classification Logistics regression model, and p0. 05 was statistically significant. Results after univariate analysis, sex, age, infectious disease, white blood cell count, partial thrombin activation time, alanine aminotransferase, creatine kinase isoenzyme, blood K were found in 24 critically ill children undergoing mechanical ventilation. Blood Na PH, partial pressure of oxygen, partial pressure of carbon dioxide, platelet count, serum creatinine, platelet hematocrit, mean platelet volume, blood glucose level did not affect the prognosis of children with severe mechanical ventilation, critical grade of children, serum albumin level. The levels of lactate dehydrogenase, serum calcium, hospitalization time, procalcitonin and mechanical ventilation time had influence on the prognosis of children with PICU. The stepwise regression analysis of multiple factors showed that the critical disease score and serum albumin level were significantly increased in children with PICU. Lactate dehydrogenase, blood calcium and length of stay were independent risk factors for prognosis of critically ill children. Conclusion critical illness score, serum albumin level, lactate dehydrogenase and serum calcium can be used as a reference index to evaluate the prognosis of children undergoing mechanical ventilation in intensive care unit of pediatric medicine, and the hospital stay is a favorable factor for prognosis. Procalcitonin has a certain effect on prognosis of children undergoing mechanical ventilation. In the course of treatment of children with PICU mechanical ventilation, clinicians should pay close attention to the unfavorable factors that may lead to the failure of the treatment of children with mechanical ventilation, make relevant prevention and treatment plans early, and improve the prognosis of severe children with mechanical ventilation to the greatest extent. Reduce mortality in critically ill children.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R725.6

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