儿童脓毒性休克的临床特点及死亡危险因素分析
发布时间：2019-01-23 15:31
【摘要】：目的：总结脓毒性休克的临床特征,探讨脓毒性休克死亡危险因素,以利于临床上对该病的早期认识、提高脓毒性休克抢救成功率。 方法：对2006年3月-2011年11月广西医科大学第一附属医院儿科重症监护病房(PICU)的83例确诊脓毒性休克住院患儿进行回顾性分析,研究因素包括年龄、性别、临床表现、血白细胞计数(WBC)、血红蛋白(HGB)浓度、血小板(PLT)计数、血清总蛋白浓度(TP)、血清白蛋白浓度(ALB)、动脉血气分析,C-反应蛋白(CRP)、血沉(ESR)、血糖、细菌内毒素、真菌葡聚糖、病原学检查、感染部位、原发病、功能障碍脏器数目、是否需机械通气、液体复苏时间等,统计学分析：1)总结脓毒性休克的临床特点2)探讨脓毒性休克死亡危险因素。 结果：1.本组资料中脓毒性休克总病死率32.5%,其中合并多脏器功能障碍(MODS)的发生率为74.5%,死亡率高达59.09%；脏器损害中肺是最常受累器官。2.本组脓毒性休克患儿死亡组的低血压发生率较非死亡组高,差别有统计学意义(P0.05)。3.本组脓毒性休克多发生于原发病治疗中,原发病以血液系统疾病、肺炎及消化器官先天发育异常最多见,其中血液系统疾病占40.96%,居脓毒性休克死亡原发病首位。4.本研究中死亡组脓毒性休克患儿液体复苏时间较非死亡组长,休克持续时间长。5.死亡组脓毒性休克患儿较非死亡组病原菌培养阳性率高(P0.05)。6.单因素分析结果表明,药物复苏时间长、动脉血气酸碱度(PH)7.35、合并多器官功能受损、病原菌培养阳性4个影响因素是脓毒性休克的死亡危险因素。年龄、性别、住院时间、低血压、白细胞及中性粒细胞计数、HGB、血小板计数、C-反应蛋白、血浆白蛋白浓度、剩余碱(BE)、ESR、血糖、细菌内毒素、真菌葡聚糖、机械通气与脓毒性休克死亡关联无统计学意义。但多因素Logistic回归分析显示药物复苏时间长、动脉血气PH7.35、合并多器官功能受损、病原体培养阳性4个影响因素与死亡的关联均无统计学意义(P0.05)。 结论：1.儿童脓毒性休克死亡率高,早期识别和积极液体复苏有利于降低其死亡率。2.单因素分析复苏时间长、动脉血气PH7.35、合并多器官功能障碍、病原菌培养阳性是脓毒性休克的死亡危险因素。3.加强预防院内感染也是降低脓毒性休克发生率及死亡风险的关键。4.早期识别的线索：原发病、微循环功能障碍指导意义更大。
[Abstract]:Objective: to summarize the clinical features of septic shock and to explore the risk factors of septic shock, so as to promote the early understanding of septic shock and improve the success rate of rescuing septic shock. Methods: 83 hospitalized children with septic shock in pediatric intensive care unit (PICU) of the first affiliated Hospital of Guangxi Medical University from March 2006 to November 2011 were analyzed retrospectively. The factors included age, sex and clinical manifestation. White blood cell count (WBC), hemoglobin (HGB) concentration, platelet (PLT) count, serum total protein concentration (TP), serum albumin concentration (ALB), arterial blood gas analysis, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), blood glucose, Bacterial endotoxin, fungal dextran, etiology, site of infection, primary disease, number of organs with dysfunction, need mechanical ventilation, time of fluid resuscitation, etc. Statistical analysis: 1) summarize the clinical features of septic shock 2) explore the death risk factors of septic shock. Results: 1. The mortality rate of septic shock was 32.5%, of which the incidence of multiple organ dysfunction (MODS) was 74.55.The mortality rate was 59.09.The lung was the most frequently involved organ in organ damage. 2. The incidence of hypotension in the death group of septic shock patients was higher than that in the non-death group (P0.05). Most of the septic shock occurred in the treatment of primary diseases. Hematological diseases, pneumonia and abnormal congenital development of digestive organs were the most common diseases, of which hematological diseases accounted for 40.96, leading to death from septic shock. In this study, the fluid resuscitation time of septic shock children in death group was longer than that of non-death group, and the duration of shock was 5. 5%. The positive rate of bacterial culture in septic shock group was higher than that in non-dead group (P0.05). Univariate analysis showed that the death risk factors of septic shock were long time of drug resuscitation, (PH) 7.35 of arterial blood gas pH, damage of multiple organ function and positive culture of pathogenic bacteria. Age, sex, length of stay, hypotension, leukocyte and neutrophil count, HGB, platelet count, C-reactive protein, plasma albumin concentration, residual alkali (BE), ESR, glucose, bacterial endotoxin, fungal dextran, There was no significant correlation between mechanical ventilation and septic shock death. But multivariate Logistic regression analysis showed that drug resuscitation time was long, arterial blood gas PH7.35, combined with multiple organ function damage, pathogen culture positive four factors were not significantly related to death (P0.05). Conclusion: 1. The mortality rate of septic shock in children is high, and early identification and active fluid resuscitation can reduce the mortality rate. 2. 5%. Univariate analysis showed that the mortality risk factors of septic shock were long resuscitation time, arterial blood gas PH7.35, combined with multiple organ dysfunction, positive culture of pathogenic bacteria. Strengthening the prevention of nosocomial infection is also the key to reduce the incidence of septic shock and the risk of death. 4. Clues for early identification: primary disease, microcirculation dysfunction is more instructive.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R720.597
本文编号：2413945
[Abstract]:Objective: to summarize the clinical features of septic shock and to explore the risk factors of septic shock, so as to promote the early understanding of septic shock and improve the success rate of rescuing septic shock. Methods: 83 hospitalized children with septic shock in pediatric intensive care unit (PICU) of the first affiliated Hospital of Guangxi Medical University from March 2006 to November 2011 were analyzed retrospectively. The factors included age, sex and clinical manifestation. White blood cell count (WBC), hemoglobin (HGB) concentration, platelet (PLT) count, serum total protein concentration (TP), serum albumin concentration (ALB), arterial blood gas analysis, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), blood glucose, Bacterial endotoxin, fungal dextran, etiology, site of infection, primary disease, number of organs with dysfunction, need mechanical ventilation, time of fluid resuscitation, etc. Statistical analysis: 1) summarize the clinical features of septic shock 2) explore the death risk factors of septic shock. Results: 1. The mortality rate of septic shock was 32.5%, of which the incidence of multiple organ dysfunction (MODS) was 74.55.The mortality rate was 59.09.The lung was the most frequently involved organ in organ damage. 2. The incidence of hypotension in the death group of septic shock patients was higher than that in the non-death group (P0.05). Most of the septic shock occurred in the treatment of primary diseases. Hematological diseases, pneumonia and abnormal congenital development of digestive organs were the most common diseases, of which hematological diseases accounted for 40.96, leading to death from septic shock. In this study, the fluid resuscitation time of septic shock children in death group was longer than that of non-death group, and the duration of shock was 5. 5%. The positive rate of bacterial culture in septic shock group was higher than that in non-dead group (P0.05). Univariate analysis showed that the death risk factors of septic shock were long time of drug resuscitation, (PH) 7.35 of arterial blood gas pH, damage of multiple organ function and positive culture of pathogenic bacteria. Age, sex, length of stay, hypotension, leukocyte and neutrophil count, HGB, platelet count, C-reactive protein, plasma albumin concentration, residual alkali (BE), ESR, glucose, bacterial endotoxin, fungal dextran, There was no significant correlation between mechanical ventilation and septic shock death. But multivariate Logistic regression analysis showed that drug resuscitation time was long, arterial blood gas PH7.35, combined with multiple organ function damage, pathogen culture positive four factors were not significantly related to death (P0.05). Conclusion: 1. The mortality rate of septic shock in children is high, and early identification and active fluid resuscitation can reduce the mortality rate. 2. 5%. Univariate analysis showed that the mortality risk factors of septic shock were long resuscitation time, arterial blood gas PH7.35, combined with multiple organ dysfunction, positive culture of pathogenic bacteria. Strengthening the prevention of nosocomial infection is also the key to reduce the incidence of septic shock and the risk of death. 4. Clues for early identification: primary disease, microcirculation dysfunction is more instructive.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R720.597
【参考文献】
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1 赵毅斌;唐国军;肖曙芳;;脓毒性休克患儿液体复苏临床意义探讨[J];中国医疗前沿;2009年21期
，本文编号：2413945
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