Clinical characteristics and prognosis of exchange transfusion in infants with severe pertussis.

IF 2 3区 医学 Q2 PEDIATRICS
Pingping Liu, Zhenghui Xiao, Jiaotian Huang, Yanying Chen, Juan Liu
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引用次数: 0

Abstract

Background: To explore the efficacy and clinical significance of exchange transfusion (ET) therapy in infants with severe pertussis, and provide a basis for the diagnosis and treatment of severe pertussis.

Methods: 45 infants diagnosed with severe pertussis and receiving ET treatment in the intensive care unit of Hunan Children's Hospital from January 1, 2019 to June 30, 2024 were selected as the study subjects. According to the prognosis, they were divided into surviving group (n = 35) and mortality group (n = 10), and the clinical manifestations and biochemical indicators of the two groups were compared. The comparison between groups of count data was conducted using the chi square test. The t-test is used to compare between groups whose measurement data conforms to a normal distribution; The Mann Whitney U test is used to compare between groups that do not follow a normal distribution.

Results: The mortality of 45 infants with severe pertussis who received ET treatment was 22.2% (10/45). The incidences of oliguria, bradycardia, and pleural effusion in the mortality group were higher than those in the surviving group, and the differences were statistically significant (P < 0.05). The white blood cells (WBC) and neutrophils (NE) in mortality group were significantly higher than those in surviving group before ET treatment. After 24 h and 48 h of ET treatment, the WBC and NE in mortality group were still higher than those in surviving group (P < 0.05). There were no statistically significant differences in WBC and NE between the two groups 72 h after ET treatment (P > 0.05). The levels of C-reactive protein (CRP), procalcitonin (PCT), N-terminal B-type natriuretic peptide precursor (NT-BNP), creatinine (Cr), lactate dehydrogenase (LDH), creatine kinase (CK), and myoglobin (MYO) in mortality group were all higher than those in surviving group before ET therapy (P < 0.05). The PH and PO2 levels in the blood gas analysis of mortality group were lower than those of surviving group before ET treatment, while PCO2 and lactate (Lac) levels were higher than those of mortality group (P < 0.05). The incidences of pulmonary hypertension, heart failure, cardiogenic shock, acute kidney injury, and pertussis encephalopathy in mortality group were higher than those in surviving group, and the differences were statistically significant (P < 0.05). The usage rates of hormones and vasoactive drugs in mortality group were higher than those in surviving group (P < 0.05).

Conclusions: ET is an important treatment for improving the prognosis of infants with severe pertussis. Infants with severe pertussis who undergo ET have a higher peak WBC count, and those with concomitant pulmonary arterial hypertension, cardiac, renal, neurological dysfunction have a poorer prognosis. Early intervention and active treatment are necessary.

Abstract Image

重症百日咳患儿换血的临床特点及预后。
背景:探讨换血(ET)治疗婴儿重症百日咳的疗效及临床意义,为重症百日咳的诊断和治疗提供依据。方法:选取2019年1月1日至2024年6月30日在湖南省儿童医院重症监护室确诊并接受ET治疗的45例重症百日咳患儿为研究对象。根据预后情况将患者分为存活组(n = 35)和死亡组(n = 10),比较两组患者的临床表现和生化指标。计数资料组间比较采用卡方检验。t检验用于测量数据符合正态分布的组之间的比较;Mann Whitney U检验用于比较不服从正态分布的组之间的差异。结果:45例重症百日咳患儿接受ET治疗的死亡率为22.2%(10/45)。死亡组少尿、心动过缓、胸腔积液发生率高于存活组,差异有统计学意义(P < 0.05)。死亡组c反应蛋白(CRP)、降钙素原(PCT)、n端b型利钠肽前体(NT-BNP)、肌酐(Cr)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌红蛋白(MYO)水平均高于ET治疗前存活组(死亡组血气分析中P 2水平低于ET治疗前存活组)。PCO2和乳酸(Lac)水平高于死亡组(P)结论:ET治疗是改善重症百日咳患儿预后的重要治疗手段。重度百日咳患儿经ET治疗后WBC峰值计数较高,同时伴有肺动脉高压、心脏、肾脏、神经功能障碍的患儿预后较差。早期干预和积极治疗是必要的。
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来源期刊
BMC Pediatrics
BMC Pediatrics PEDIATRICS-
CiteScore
3.70
自引率
4.20%
发文量
683
审稿时长
3-8 weeks
期刊介绍: BMC Pediatrics is an open access journal publishing peer-reviewed research articles in all aspects of health care in neonates, children and adolescents, as well as related molecular genetics, pathophysiology, and epidemiology.
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