恶性血液肿瘤患儿合并脓毒性休克死亡危险因素分析

发布时间：2018-02-26 12:18

本文关键词： 儿童血液肿瘤脓毒性休克危险因素　出处：《中国实用儿科杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的探讨儿童重症监护病房(PICU)恶性血液肿瘤合并脓毒性休克患儿的临床特点及其死亡危险因素。方法对中山大学孙逸仙纪念医院PICU 2012年3月至2015年9月收治的43例恶性血液肿瘤合并脓毒性休克患儿的临床资料进行回顾性分析。结果43例休克患儿中,存活27例,死亡16例,病死率37.2%。最常见感染部位为肺部(74.4%),其次为胃肠道(39.5%)。病原学检查阳性者26例,共分离出病原菌43株,其中G+菌5株(11.6%),G-菌31株(72.1%),真菌7株(16.3%),以大肠埃希菌占首位(6/43,14.0%)。存活组与死亡组比较,患儿在年龄、化疗阶段、感染至休克累计时间、粒细胞缺乏至休克累计时间、多器官功能障碍(MODS)受累器官数、肺部受累、低钙血症、液体复苏后6 h的氧合指数及乳酸水平、多巴胺使用剂量以及是否需要机械通气方面,差异均具有统计学意义(P均0.05)。多因素Logistic回归分析结果显示:与脓毒性休克患儿死亡相关的变量为液体复苏后6 h的乳酸水平及机械通气的应用。结论恶性血液肿瘤合并脓毒性休克经液体复苏后6 h仍存在高乳酸中毒、合并低钙血症以及需要机械通气的患儿病死率高,应更为重视。
[Abstract]:Objective to investigate the clinical characteristics and risk factors of death in children with malignant hematoma complicated with septic shock in children's intensive care unit (ICU). Methods 43 patients admitted to Sun Yat-Sen Memorial Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University from March 2012 to September 2015 were enrolled in this study. The clinical data of 43 children with malignant hematologic tumor complicated with septic shock were retrospectively analyzed. 27 cases survived, 16 cases died, and the mortality was 37.2%. The most common site of infection was lung 74.4%, followed by gastrointestinal tract 39.55.The pathogen was positive in 26 cases, and 43 strains of pathogenic bacteria were isolated. Among them, there were 5 strains of G bacteria, 31 strains of G- bacteria, 72.1% of them, 7 strains of fungi, 7 strains of fungi, among which Escherichia coli accounted for the first 6 / 43% and 14.0%. Compared with the dead group, the age, chemotherapy stage, cumulative time of infection to shock, the time of granulocytosis to shock, the time of granulocytosis to shock in the survival group were higher than those in the dead group. The number of involved organs, lung involvement, hypocalcemia, oxygenation index and lactate level at 6 hours after fluid resuscitation, dopamine dosage, and whether mechanical ventilation is required. The results of multivariate Logistic regression analysis showed that the variables associated with death in septic shock were the level of lactic acid 6 hours after fluid resuscitation and the application of mechanical ventilation. Conclusion\\\; Hyperlactic acid poisoning still existed 6 hours after fluid resuscitation in the tumor complicated with septic shock. More attention should be paid to the mortality of children with hypocalcemia and need of mechanical ventilation.
【作者单位】：中山大学孙逸仙纪念医院PICU;
【分类号】：R720.597;R733

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