Objective:To summarize and analyze the clinical features of severe respiratory syncytial virus(RSV)pneumonia in children in Nanchang area,and to explore the risk factors of severe disease.Methods:Clinical data of 439 children with severe RSV pneumonia hospitalized in Jiangxi Children's Hospital from January 1,2019 to December 31,2021 were retrospectively studied.They were divided into severe group(240 cases)and critical group(199 cases).The general clinical data,laboratory indicators,clinical manifestations and complications,imaging manifestations,treatment and outcomes of the two groups of children were compared,and the clinical characteristics of severe RSV pneumonia in children were summarized.Multivariate Logistic regression analysis was used to studys the risk factors of severe illness.Results:The male to female ratio of the two groups was 2.54∶1,and the median age was 2.6(1.6,6.6)months,of which 322 patients(73.4%)were less than 6 months old.It occured throughout the year and was popular in winter and spring.Hemoglobin(Hb),pH and partial pressure of arterial oxygen(PaO2)in the critically ill group were lower than those in the severely ill group,while platelet count(PLT)and initial value of calcitonin(PCT)were higher than those in the severely ill group,and the difference between the two groups was statistically significant(P＜0.05).There was significant difference in co-infection between the two groups(P＜0.05).The detection rate of co-virus infection was significantly higher than that of bacteria,and cytomegalovirus infection was dominant.Legionella is the most common bacterial infection.There was no significant difference in the main clinical manifestations(fever,cough,wheezing and shortness of breath)between the two groups(P＞0.05),while there was significant difference in the secondary clinical manifestations(cyanosis,spitting,dyspnea,convulsions,etc.)between the two groups(P＜0.05),and respiratory failure was the most serious complication in 160 cases(80.5%).Pulmonary patchy shadow was predominant in both groups,and atelectasis was more likely to occur in the critical group than in the severe group,with statistically significant(P＜0.05).The oxygen therapy rate of the critical group was higher than that of the severe group(100%vs 95.4%),and the proportion and duration of invasive ventilator-assisted ventilation in the critical group were significantly higher than those in the severe group,with statistical significance(P＜0.05).The proportion of intravenous gamma globulin use in severe group was higher than that in severe group(85.9%vs 36.7%),and the difference was statistically significant(P＜0.05).The proportion of three or more antibiotics used in severe group was higher than that in severe group(47.2%vs 15.4%),and the difference was statistically significant(P＜0.05),but there was no statistically significant difference in the use time between the two groups(P＞0.05).The days of hospitalization and ICU stay in severe group were shorter than those in critical group,and the difference was statistically significant(P＜0.05).Logistic regression analysis showed that combined underlying disease and mixed infection were independent risk factors for severe RSV pneumonia.Conclusion:⑴ The predilection age of severe RSV pneumonia in children in Nanchang area was less than 6 months,mainly in male children.It occured all year round and was prevalent in winter and spring.⑵ Fever,cough,asthma and shortness of breath were the main clinical manifestations,and most of the complications were respiratory failure.⑶ Lower HGB,lower pH,lower PaO2,higher PLT,higher PCT could better reflect the severity of the disease;Pulmonary patchy shadows were predomi-nant in imaging,and atelectasis was more common in the critical type group.⑷ Combined underlying diseases and mixed infection were independent risk factors for severe RSV pneumonia.⑸ Most children with severe RSV pneumonia could get better and be discharged from hospital.The disease burden of the critically ill group was heavier.
维普
万方数据