探讨急诊科呼吸困难患儿预后影响因素。

采用回顾性分析方法对2013年10月至2014年10月因呼吸困难于四川大学华西第二医院急诊科抢救室救治的364例病历资料完整的患儿进行分析。其中，男性患儿为230例(63.2%)，女性为134例(36.8%)；年龄为1个月至13岁，中位年龄为7个月。结合小儿死亡危险(PRISM)Ⅲ评分、相关参考文献及急诊科常用生化检测指标，选取性别、年龄、是否进行有创通气、是否合并先天性疾病、是否入住儿科重症监护病房(PICU)、心率、血红蛋白水平、血细胞比容、血Ca^2＋水平、血清白蛋白水平、动脉血pH值、经皮脉搏血氧饱和度(SpO₂)、动脉血氧饱和度(SaO₂)、动脉二氧化碳分压(PaCO₂)、动脉血氧分压(PaO₂)、血乳酸水平及剩余碱水平等共计17个指标，作为可能影响急诊科呼吸困难患儿预后的影响因素。详细记录上述17个指标情况及患儿主要诊断与预后情况。对不同影响因素下急诊科呼吸困难患儿预后不良发生率进行统计学比较。再根据上述比较中有统计学意义的因素，并结合已有研究结果及专业知识，选择影响急诊科呼吸困难患儿预后相关因素进行非条件多因素logistic回归分析。本研究遵循的程序符合四川大学华西第二医院人体试验委员会制定的伦理学标准，得到该委员会批准。

①进行有创通气、入住PICU、合并先天性疾病，以及血Ca^2＋水平、SpO₂、PaO₂及剩余碱水平异常患儿的预后不良发生率(38.4%、30.8%、30.8%、23.7%、34.7%、31.7%、23.3%)，显著高于未进行有创通气、未入住PICU、未合并先天性疾病，以及血Ca^2＋水平、SpO₂、PaO₂及剩余碱水平正常患儿(13.1%、11.9%、11.9%、12.1%、15.6%、16.4%、13.9%)，并且差异均有统计学意义(χ²＝25.161、19.456、19.456、8.255、10.463、5.736、5.338，P<0.05)。不同性别、年龄，以及心率、动脉血pH值、血红蛋白水平、血细胞比容、血清白蛋白水平、SaO₂、PaCO₂及血乳酸水平是否异常患儿的预后不良发生率比较，差异均无统计学意义(P>0.05)。②对急诊科呼吸困难患儿预后影响因素的非条件多因素logistic回归分析结果显示，是否进行有创通气、是否入住PICU、是否合并先天性疾病、血Ca^2＋水平及SpO₂，为影响急诊科呼吸困难患儿预后的独立危险因素(OR＝2.521、2.260、3.867、1.992、2.225，95% CI：1.244～5.109、1.112～4.594、2.122～7.045、1.068～3.719、1.059～4.677，P＝0.010、0.024、0.000、0.030、0.035)。

对于急诊科呼吸困难患儿，急诊科医师应高度重视患儿是否合并先天性疾病、是否进行有创通气、是否入住PICU、血Ca^2＋水平及SpO₂等危险因素，这对呼吸困难患儿在急诊科的临床诊治具有指导意义。

To identify the prognosis factors for children with dyspnea in emergency department.

From October 2013 to October 2015, a total of 364 cases of children with dyspnea whose medical records were complete in Department of Emergency, West China Second University Hospital, Sichuan University were selected as research subjects. Among them, 230 (63.2%) cases were boys and 134 (36.8%) cases were girls. The age was 1 month to 13 years old and the median age was 7 months old. According to pediatric risk of mortality (PRISM) Ⅲ score, relevant references and biochemical indicators detected in emergency department, age, gender, received mechanical ventilation or not, combined with congenital disease or not, admitted to pediatric intensive care unit (PICU) or not, heart rate, level of hemoglobin, hematocrit, serum Ca²⁺ concentration, level of plasma albumin, arterial pH value, hemoglobin oxygen saturation by pulse oximetry (SpO₂), arterial oxygen saturation (SaO₂), partial pressure of carbon dioxide (PaCO₂), partial pressure of oxygen (PaO₂), level of blood lactate and base excess were selected as possible prognosis factors for children with dyspnea in emergency department. Retrospective method was used to analyze the clinical data, those 17 possible prognosis factors and the main diagnosis and prognosis were recorded. The rates of unfavourable prognosis of each possible prognosis factors were compared by chi-square test. According to the significant positive factors in chi-square test, and considering the other research results and professional knowledge, 8 factors were further processed as independent variables when the prognosis set as dependent variable in a multivariate unconditional logistic regression model. The study protocol was approved by the Ethical Review Board of Investigation in West China Second University Hospital, Sichuan University.

①The rates of unfavourable prognosis of mechanical ventilation, admitted to PICU, combined with congenital disease, abnormal serum Ca²⁺ concentration, SpO₂, PaO₂ and base excess (38.4%, 30.8%, 30.8%, 23.7%, 34.7%, 31.7%, 23.3%) were higher than those without mechanical ventilation, didn't admitted to PICU, without congenital disease, with normal serum Ca²⁺ concentration, SpO₂, PaO₂ and base excess (13.1%, 11.9%, 11.9%, 12.1%, 15.6%, 16.4%, 13.9%), respectively, and all the differences were statistically significant (χ²=25.161, 19.456, 19.456, 8.255, 10.463, 5.736, 5.338; P<0.05). The rates of unfavourable prognosis between different ages, gender, heart rate, level of hemoglobin, hematocrit, level of plasma albumin, arterial pH value, SaO₂, PaCO₂ and level of blood lactate, there were no statistical significances (P>0.05). ②According to the multivariate logistic regression analysis result, mechanical ventilation, admitted to PICU, congenital disease, abnormal serum Ca²⁺ concentration and SpO₂ were independent risk factors for prognosis of children with dyspnea in emergency department (OR=2.521, 2.260, 3.867, 1.992, 2.225; 95% CI: 1.244-5.109, 1.112-4.594, 2.122-7.045, 1.068-3.719, 1.059-4.677; P=0.010, 0.024, 0.000, 0.030, 0.035).

As to children with dyspnea in emergency department, emergency physicians should pay much attention to independent risk factors of their prognosis, such as mechanical ventilation, admitted to PICU, congenital disease, serum Ca²⁺ concentration and SpO₂ which may play an active role on treating children with dyspnea in emergency department.