年度会议摘要雷竞技app下载苹果版

公共卫生大会2018:在严重营养不良的儿童肺炎菌血症的危险因素及其结果-阿布萨达特Mohammad Sayeem本Shahid国际腹泻病研究中心

文摘

问题的声明:菌血症是相当常见的严重急性营养不良的儿童(SAM)肺炎,常常经历一个致命的结果,特别是在发展中国家。医学文献中有有限的信息在山姆儿童肺炎菌血症的风险。我们已经检查了菌血症的相关因素及其结果在5岁以下儿童住院的儿童肺炎和山姆的管理。方法和理论取向:在这个无与伦比的病例对照研究中,山姆儿童的性别、年龄0-59月,承认达卡医院国际腹泻病研究中心的孟加拉国(位于咳嗽或呼吸窘迫和放射性肺炎在2011年4月至2012年7月被录取(n = 405)。那些有肺炎及菌血症构成情况(n = 18)和随机选择山姆肺炎患儿没有菌血症构成控制(n = 54)。发现:广泛的细菌病原体分离其中13例(72%)病例中是革兰氏阴性。在病例死亡率高于对照组(28%比9%),但差异无统计学意义(p = 0.111)。在逻辑回归分析中,在调整了潜在的混杂因素,如缺乏DPT /口服脊髓灰质炎/艾滋病毒/肝炎疫苗、麻疹疫苗接种、呕吐和脱水的临床(一些/严重)山姆儿童肺炎及菌血症往往有缺乏BCG疫苗接种史(95% CI = 1.17 - -29.98),舒张期血压过低(< 50 mm Hg) (95% CI = 1.01 - 12.86)不仅纠正脱水后也没有。结论和意义:我们的研究结果表明,缺乏BCG疫苗接种史和舒张期低血压在没有脱水入院时的独立预测因子在山姆儿童肺炎菌血症。结果表明接种卡介苗的延续的重要性的主要好处是产生很大的好处。 Background Risks of death are high when children with pneumonia also have severe acute malnutrition (SAM) as a co-morbidity. However, there is limited published information on risk factors of death from pneumonia in SAM children. We evaluated clinically identifiable factors associated with death in under-five children who were hospitalized for the management of pneumonia and SAM. Methods For this unmatched case-control design, SAM children of either sex, aged 0–59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) during April 2011 to July 2012 with radiological pneumonia were studied. The SAM children with pneumonia who had fatal outcome constituted the cases (n = 35), and randomly selected SAM children with pneumonia who survived constituted controls (n = 105). Results The median (inter-quartile range) age (months) was comparable among the cases and the controls [8.0 (4.9, 11.0) vs. 9.7 (5.0, 18.0); p = 0.210)]. In logistic regression analysis, after adjusting for potential confounders, such as vomiting, abnormal mental status, and systolic hypotension (<70 mm of Hg) in absence of dehydration, fatal cases of severely malnourished under-five children with pneumonia were more often hypoxemic (OR = 23.15, 95% CI = 4.38–122.42), had clinical dehydration (some/severe) (OR = 9.48, 95% CI = 2.42–37.19), abdominal distension at admission (OR = 4.41, 95% CI = 1.12–16.52), and received blood transfusion (OR = 5.50, 95% CI = 1.21–24.99) for the management of crystalloid resistant systolic hypotension. Discussion We observed that blood transfusion used for the management of refractory systolic hypotension revealed as the independent predictor for death in under-five SAM children with pneumonia – a very important information for clinicians in critical care wards of developing countries. WHO recommends blood transfusion in severely malnourished children who do not recover from septic shock even after infusion of consecutive two boluses of isotonic fluid[8]。protocolized管理这些孩子在我们医院遵循这一建议[13]。收缩期血压过低,除了脓毒症的特点(定义为我们当地的准则)[15],[16],作为山姆儿童脓毒性休克的标志,特别是在资源有限的设置。孩子与收缩压低血压和对晶体接受输血但没有收到利尿剂和频繁的致命的结果。我们没有任何准备解释这一发现。我们所有的研究儿童接受了输血由于感染性休克折射液治疗,这可能是由于感染性心肌功能障碍的特点是射血分数减少心室的扩张。死于自闭症这个特殊的群体往往是很高的即使有足够的治疗不仅在发展中国家,也在发达国家。然而,输血的影响心脏功能恶化在山姆的孩子还不清楚。最近的数据表明,降低肺的肺泡上皮钠和氯运输山姆孩子妨碍间隙从肺泡渗出的液体。这可能导致间质水肿和心力衰竭的发展在我们的研究中儿童接受输血除了接受透明的液体。然而,流体过载/心力衰竭临床证据并不是不同的情况下和控制。因此,肺水肿,肺的常见病因死亡儿童山姆,可能不是负责输血的不利影响我们的研究。 Although an earlier study conducted in Mulago hospital, Uganda experienced significant higher deaths after blood transfusion related to pulmonary edema in SAM children compared to those who did not receive blood transfusion, most of the indications of blood transfusions in that study were other than septic shock and often the use of blood transfusion was not judicious. We did not evaluate the cardiac function of these children to exclude fluid overload as a consequence of blood transfusion. A recent study has reported cardiovascular collapse rather than fluid overload to contribute to excess death from rapid fluid resuscitation in well nourished children with septic shock; however, cardiac function in SAM children with septic shock has not been explored yet, which needs to be addressed in carefully conducted patho-physiologic studies in future. Conclusion and Significance We identified hypoxemia, clinical dehydration, and abdominal distension as the independent predictors of death in SAM children with pneumonia. SAM children with pneumonia who required blood transfusion for the management of crystalloid resistant systolic hypotension were also at risk for death. Thus, early identification and prompt management of these simple clinically recognizable predictors of death and discourage the use of blood transfusion for the management of crystalloid resistant systolic hypotension may help reduce deaths in such population.

阿布萨达特穆罕默德Sayeem本舍希德,Tahmeed Ahmed K M Shahunja Mohammod Jobayer Chisti

阅读全文下载全文