PICU中儿童脓毒症临床特点和预后相关因素分析

发布时间：2018-01-31 00:48

本文关键词： 脓毒症临床特点预后儿童　出处：《临床儿科杂志》2017年10期 　论文类型：期刊论文

【摘要】：目的探讨PICU中无基础疾病脓毒症患儿的临床特点及预后相关因素。方法回顾2014年2月至2016年6月PICU收治的110例无基础疾病的脓毒症患儿临床资料。根据脓毒症严重程度将患儿分为脓毒症组、严重脓毒症组、脓毒性休克组,根据PICU入住28天时的预后情况将患儿分为存活组、死亡组;比较各组间的差异。结果 110例无基础疾病的脓毒症患儿中,男74例、女36例,中位年龄0.42岁。肺部感染为主要感染源。总病死率为14.55%。脓毒症、严重脓毒症、脓毒性休克患儿的病死率分别为2.94%、27.27%、35.48%,差异有统计学意义(P0.001);三组间降钙素原(PCT)、白细胞计数(WBC)、肌酐(Cr)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、器官功能障碍(MODS)数目、小儿危重病例评分(PCIS)、小儿多器官功能障碍评分(P-MODS)、6 h内机械通气、机械通气时间、28天预后的差异均有统计学意义(P0.05)。存活与死亡患儿比较,PCT、乳酸(Lac)、APTT、INR、MODS数目、PCIS、P-MODS、6 h内机械通气、机械通气时间、住PICU时间、住院时间、脓毒症严重程度的差异均有统计学意义(P0.05)。Logistic回归分析提示,PCIS评分高、住院时间长,患儿28天预后好;而机械通气时间长,28天预后差(P0.05)。结论 PICU内无基础疾病的脓毒症患儿,PCT、WBC、Cr、APTT、INR、MODS数目、PCIS、P-MODS、6 h内机械通气、机械通气时间有助于判断病情严重程度;PCIS、机械通气时间、住院时间影响预后。
[Abstract]:Objective to investigate the clinical characteristics and prognostic factors of sepsis without basic diseases in PICU. Methods from February 2014 to June 2016, 110 cases of sepsis without basic diseases were reviewed in PICU. According to the severity of sepsis, the children were divided into sepsis group. Severe sepsis group and septic shock group were divided into survival group and death group according to the prognosis of PICU at 28 days. Results among 110 children with sepsis without basic diseases, 74 were male and 36 were female. The median age was 0.42 years old. Pulmonary infection was the main source of infection. The total mortality rate was 14.55. The mortality of children with sepsis, severe sepsis and septic shock were 2.94% and 27.27% respectively. 35.48, the difference was statistically significant (P 0.001); Among the three groups, the levels of procalcitonin (PCT), white blood cell count (WBC), creatinine (Cr), activated partial thromboplastin time (APTTT), and international standard ratio (INR) were measured. The number of MODSs, the scores of critical cases in children and the scores of multi-organ dysfunction in children were compared. The mechanical ventilation and mechanical ventilation time within 6 hours were found in children with multiple organ dysfunction. There were significant differences in the prognosis of 28 days between the two groups (P 0.05). The number of PCT, lactic acid lactic acid (lactic acid) and APTTT / INR mods were compared with those of the dead children (P < 0. 05). The duration of mechanical ventilation, mechanical ventilation, PICU stay and hospital stay were 6 h after P-MODS. The difference of severity of sepsis was statistically significant (P 0.05). Logistic regression analysis showed that PCIS score was high, hospital stay was long and prognosis was good in 28 days. The prognosis of patients with sepsis without underlying diseases in PICU was poor (P 0.05) after 28 days of mechanical ventilation. Conclusion the number of INR mods in patients with sepsis without underlying diseases in PICU is higher than that in control group. The mechanical ventilation time of PCIS-P-MODS within 6 h is helpful to judge the severity of the disease. PCIS, duration of mechanical ventilation and length of stay affect prognosis.
【作者单位】：上海交通大学医学院附属上海儿童医学中心儿童重症医学科;
【分类号】：R720.597
【正文快照】： 脓毒症是指由感染引起的全身炎症反应综合征,是导致儿童死亡的主要原因之一。目前关于儿童脓毒症的研究逐渐增多,但关于平素身体健康儿童发生的脓毒症相关临床研究较少。本研究拟对2014年2月至2016年6月上海儿童医学中心儿童重症监护室(PICU)收治的无基础疾病的脓毒症患儿的临

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