脓毒症并发毛细血管渗漏综合征的危险因素分析

发布时间：2018-01-02 14:39

本文关键词：脓毒症并发毛细血管渗漏综合征的危险因素分析　出处：《中国全科医学》2016年36期 　论文类型：期刊论文

【摘要】：目的探讨脓毒症并发毛细血管渗漏综合征(CLS)的危险因素,为临床早期筛查、及时干预提供理论依据。方法收集2007年6月—2015年6月海南省人民医院儿科收治的321例脓毒症患儿的临床资料,根据是否并发CLS将患儿分为非CLS组298例和CLS组23例。以患儿入院为观察起点,死亡或出院为观察终点。比较两组患儿临床治疗结果及年龄、性别、营养不良发生情况、白细胞计数(WBC)、血清降钙素原(PCT)水平、血清C反应蛋白(CRP)水平、空腹血糖≥6.67 mmol/L发生情况、血清肿瘤坏死因子α(TNF-α)水平、血清乳酸水平、凝血功能障碍发生情况、小儿危重症评分(PCIS)、休克发生情况、多器官功能障碍综合征(MODS)累及脏器≥3个发生情况、脓毒症治疗1 h内抗生素应用情况及6 h目标复苏治疗情况;采用多因素Logistic回归分析脓毒症患儿并发CLS的影响因素。结果非CLS组患儿治愈率高于CLS组患儿(χ2=41.309,P0.001)。两组患儿年龄、性别、营养不良发生率、WBC、脓毒症治疗1 h内抗生素应用率、6 h目标复苏治疗率比较,差异无统计学意义(P0.05);CLS组患儿血清PCT水平、血清CRP水平、血糖≥6.67 mmol/L发生率、血清TNF-α水平、血清乳酸水平、凝血功能障碍发生率、休克发生率、MODS累及脏器≥3个发生率高于非CLS组,PCIS低于非CLS组(P0.05)。多因素Logistic回归分析结果显示,血清乳酸水平〔OR=2.609,95%CI(1.402,4.857)〕、PCIS〔OR=0.634,95%CI(0.497,0.808)〕、休克〔OR=0.124,95%CI(0.024,0.643)〕、MODS累及脏器≥3个〔OR=0.120,95%CI(0.021,0.676)〕是脓毒症患儿发生CLS的影响因素(P0.05)。结论血清乳酸水平升高、PCIS降低、休克、MODS累及脏器≥3个的脓毒症患儿发生CLS的可能性较大,临床应注意重点监测。
[Abstract]:Objective to investigate the sepsis complicated with capillary leak syndrome (CLS) risk factors for early clinical screening, timely intervention and provide a theoretical basis. Methods clinical data of 321 cases of sepsis were collected from June 2007 to June 2015 in Department of Pediatrics of Hainan Provincial People's Hospital pus, according to whether complicated with CLS were divided into non CLS group 298 cases and group CLS 23 children in the hospital for observation. In cases of death or discharge in order to observe the starting point and end point. Two groups were compared the clinical results and age, sex, malnutrition, white blood cell count (WBC), serum procalcitonin (PCT) level of serum C reactive protein (CRP) level, the incidence of fasting blood glucose than 6.67 mmol/L, serum tumor necrosis factor alpha (TNF- alpha) levels, serum lactate levels, the incidence of blood coagulation dysfunction, pediatric critical illness score (PCIS), the incidence of shock, multiple organ dysfunction syndrome (MODS) involving the dirty For more than 3 cases of sepsis treatment within 1 h of the use of antibiotics and 6 h target recovery treatment; influence factors using multivariate Logistic regression analysis of sepsis in children with CLS. Results the cure rate of the group CLS was higher than that in CLS group (2=41.309, P0.001). The two groups of children with age. Gender, the incidence of malnutrition, WBC treatment, 1 h antibiotic application rate of sepsis, compared the rate of 6 h target recovery treatment, the difference was not statistically significant (P0.05); the serum level of PCT in group CLS, the serum level of CRP, the incidence rate of blood glucose greater than 6.67 mmol/L, the serum TNF- levels, serum lactate levels, incidence the rate of blood coagulation dysfunction, the incidence of shock, involving more than 3 MODS organs was higher than non CLS group, PCIS was lower than that in non CLS group (P0.05). Multivariate Logistic regression analysis showed that serum lactic acid level of OR=2.609,95%CI (1.402,4.857), PCIS OR=0.634,95%CI (0.497,0. 808), shock OR=0.124,95%CI (0.024,0.643), MODS = 3 OR=0.120,95%CI involving organs (0.021,0.676) is the influencing factors in children with sepsis CLS (P0.05). Conclusion increased serum lactic acid level decreased PCIS, MODS shock, the organ involved more than 3 children with sepsis had the possibility of CLS larger clinical attention should be paid to focus on monitoring.

【作者单位】：海南省人民医院儿科;
【分类号】：R459.7
【正文快照】： 毛细血管渗漏综合征(capillary leak syndrome,CLS)是指由于毛细血管内皮细胞损伤,血管通透性增加,导致大量血浆小分子蛋白渗漏到组织间隙,从而出现全身广泛的水肿、低蛋白血症、急性肾缺血、低血容量休克等表现的一组临床综合征[1]。引起CLS的病因较多,大多系脓毒症所致。CLS

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