中国实用儿科杂志2024，Vol.39Issue(9)：710-716,7.DOI:10.19538/j.ek2024090613
儿童重症百日咳临床特征及预后回顾性分析
Clinical characteristics and prognosis of severe pertussis in children:A retrospective analysis
摘要
Abstract
Objective To analyze the clinical characteristics of severe pertussis in children and explore the risk factors of the prognosis.Methods A total of 54 children diagnosed with severe pertussis who were hospitalized in the PICU of Guangzhou Women and Children's Medical Center from August 2023 to February 2024 were included.Group the enrolled children according to whether tohave undergone blood exchange or mechanical ventilation,and compare the differences in clinical characteristics among the groups.Use Kaplan-Meier survival curves and Log-rank tests to compare differences in survival rates among the groups of differentwhite blood cell and lymphocyte levels,presence or absence of pulmonary hypertension and tricuspid regurgitation;univariate and multivariate COX regression equation methods were used to analyze risk factors affecting prognosis of pediatric patients.Results A total of 54 children with severe pertussis were included,including 32 males(59.26％)and 40 children aged ≤ 3 months old(74.07％),and 5 were vaccinated(9.26％).The childrenweregrouped based on whether to exchange blood.The group comparison results showed that the exchange group had a faster heart rate(P=0.036),concomitant pulmonary hypertension(P=0.006),concomitant tricuspid regurgitation(P=0.002),mechanical ventilation(P=0.014),increased proportion of vasoactive drugs used(P＜0.001),and elevated activated prothrombin time(P=0.014)andblood creatinine(P=0.004).The patients were grouped based on whether or not tracheal intubation was performed,and the inter-group comparison results showed that the proportion of vaccination decreased(P=0.021),heart rate increased(P=0.008),the patients hadconcomitant tricuspid regurgitation(P=0.035)and blood exchange(P=0.004),and the proportion of using vasoactive drugs(P＜0.001)increased in the invasive mechanical ventilation group;hemoglobin(P=0.021)and albumin decreased(P=0.004),while CRP(P=0.004)and blood creatinine(P=0.017)increased.The K-M survival curve showed that the survival rates of children in white blood cells ≥ 36.0×109/L group(P=0.012),lymphocytes ≥ 22.49 × 109/L group(P=0.012),combined withpulmonary hypertension(P=0.003),and combined withtricuspid regurgitation group(P＜0.001)decreased.The result of the multivariate Cox regression model analysis indicated that white blood cell(HR=1.045,95％CI:1.001-1.092,P=0.046)was an independent risk factor affecting the prognosis of children with severe pertussis.The higher the white blood cell,the worse the prognosis.Conclusion When children with severe pertussis have white blood cells ≥36.0×109/L,lymphocytes ≥ 22.49×109/L,andare with pulmonary hypertension and tricuspid regurgitation,the survival rate decreases,and more active treatments are needed.Elevatedwhite blood cellis an independent risk factor affecting the prognosis of severe pertussis in children.关键词
重症百日咳/儿童/肺动脉高压/白细胞升高Key words
severe pertussis/child/pulmonary hypertension/elevated white blood cells分类
医药卫生引用本文复制引用
李雪倩,黎明,李甜,李木胜,陈飞燕,廖娟,杨洋,黄志宾,李潇男,黄菊秀,陈经纶,叶枫,尹雅斯,余雪云,余永勤,陈秋凡,李丽君,洪婕,张剑珲,陶建平,司徒勋,杨镒宇,武志远,梁宇峰..儿童重症百日咳临床特征及预后回顾性分析[J].中国实用儿科杂志,2024,39(9):710-716,7.基金项目
2023年度市校(院)企联合资助专题(编号:SL2022A03J01168) （院）
