中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2010年
4期
321-324
,共4页
脓毒症%多脏器功能不全%儿童
膿毒癥%多髒器功能不全%兒童
농독증%다장기공능불전%인동
Sepsis%Multiple organ dysfunction syndrome%Children
目的 小儿脓毒症是PICU的常见疾病,具有较高的病死率.本研究旨在了解小儿脓毒症的临床特点及转归,探寻儿童严重脓毒症的死亡危险因素.方法 分析2008年1月至12月收入我院PICU的脓毒症病例,对严重脓毒症患儿作单因素分析,并建立Logistic回归模型,探寻儿童严重脓毒症的死亡危险因素.结果 纳入脓毒症患儿103例,病死率16.5%.严重脓毒症45例,其死亡危险因素是PRISM Ⅲ评分(OR 1.502;95%CI 1.131～1.995)和病程中外周血血小板计数最高值(OR 0.991;95%CI0.982～1.000).小儿严重脓毒症伴随1、2、3、4个及4个以上脏器功能障碍的病死率分别为10.0%、11.1%、44.4%、68.8%,差异具有非常显著性(P＜0.001).最常受累的是心血管系统(75.6%)和呼吸系统(66.7%),严重脓毒症伴发MODS死亡危险因素是呼吸系统(OR 23.179;95%CI2.095～256.522)和肾脏(OR 9.637;95%CI 1.698～54.703)功能受累.结论 小儿严重脓毒症的死亡危险因素是PRISM Ⅲ评分和病程中外周血血小板计数最高值.小儿脓毒症合并MODS提示预后不良,其病死率与发生功能障碍的脏器数目呈正相关,呼吸系统和肾脏功能受累是儿童脓毒症死亡的危险因素.
目的 小兒膿毒癥是PICU的常見疾病,具有較高的病死率.本研究旨在瞭解小兒膿毒癥的臨床特點及轉歸,探尋兒童嚴重膿毒癥的死亡危險因素.方法 分析2008年1月至12月收入我院PICU的膿毒癥病例,對嚴重膿毒癥患兒作單因素分析,併建立Logistic迴歸模型,探尋兒童嚴重膿毒癥的死亡危險因素.結果 納入膿毒癥患兒103例,病死率16.5%.嚴重膿毒癥45例,其死亡危險因素是PRISM Ⅲ評分(OR 1.502;95%CI 1.131～1.995)和病程中外週血血小闆計數最高值(OR 0.991;95%CI0.982～1.000).小兒嚴重膿毒癥伴隨1、2、3、4箇及4箇以上髒器功能障礙的病死率分彆為10.0%、11.1%、44.4%、68.8%,差異具有非常顯著性(P＜0.001).最常受纍的是心血管繫統(75.6%)和呼吸繫統(66.7%),嚴重膿毒癥伴髮MODS死亡危險因素是呼吸繫統(OR 23.179;95%CI2.095～256.522)和腎髒(OR 9.637;95%CI 1.698～54.703)功能受纍.結論 小兒嚴重膿毒癥的死亡危險因素是PRISM Ⅲ評分和病程中外週血血小闆計數最高值.小兒膿毒癥閤併MODS提示預後不良,其病死率與髮生功能障礙的髒器數目呈正相關,呼吸繫統和腎髒功能受纍是兒童膿毒癥死亡的危險因素.
목적 소인농독증시PICU적상견질병,구유교고적병사솔.본연구지재료해소인농독증적림상특점급전귀,탐심인동엄중농독증적사망위험인소.방법 분석2008년1월지12월수입아원PICU적농독증병례,대엄중농독증환인작단인소분석,병건립Logistic회귀모형,탐심인동엄중농독증적사망위험인소.결과 납입농독증환인103례,병사솔16.5%.엄중농독증45례,기사망위험인소시PRISM Ⅲ평분(OR 1.502;95%CI 1.131～1.995)화병정중외주혈혈소판계수최고치(OR 0.991;95%CI0.982～1.000).소인엄중농독증반수1、2、3、4개급4개이상장기공능장애적병사솔분별위10.0%、11.1%、44.4%、68.8%,차이구유비상현저성(P＜0.001).최상수루적시심혈관계통(75.6%)화호흡계통(66.7%),엄중농독증반발MODS사망위험인소시호흡계통(OR 23.179;95%CI2.095～256.522)화신장(OR 9.637;95%CI 1.698～54.703)공능수루.결론 소인엄중농독증적사망위험인소시PRISM Ⅲ평분화병정중외주혈혈소판계수최고치.소인농독증합병MODS제시예후불량,기병사솔여발생공능장애적장기수목정정상관,호흡계통화신장공능수루시인동농독증사망적위험인소.
Objective Severe sepsis, especially complicated multiple organ dysfunction syndrome (MODS) ,remains a serious problem in pediatric intensive care unit (PICU). This study aims to explore the clinical characteristics of sepsis and the cause of death for septic patients. Methods A cohort of severe sepsis admitted to PICU between Jan 2008 and Dec 2008 was enrolled in the study. Forty six variables were included in the univariate analysis as potential risk factors for mortality in severe sepsis, followed by logistic regression analysis. Results Forty five children were enrolled with a mortality of 32. 1%. The risk factors of mortality were assessed using the PRISM Ⅲ score ( OR 1. 502;95% CI 1. 131 ～ 1.995) and maximum platelet count during hospitalization ( OR 0. 991 ;95% CI 0.982 ～ 1.000). The mortality of severe sepsis complicated with 1,2,3,4 or more organ dysfunction was 10.0%, 11.1%, 44. 4% and 68. 8 %, respectively ( P ＜ 0. 001 ). The organ dysfunction most frequently appeared in the cardiovascular system (75.6%) and respiratory system (66.7%). In severely septic children with MODS, respiratory failure (OR 23. 179; 95% CI 2.095 ～256. 522) and renal failure( OR 9. 637 ;95% CI 1. 698 ～ 54. 703) were the main risk factors of death. Conclusion The risk factors of death in severe sepsis were PRISM Ⅲ score and maximum platelet count during hospitalization. Severe sepsis combined with MODS had a poor prognosis, with a positive correlation between the number of dysfunctional organs and mortality rate. Respiratory and renal failure rate was associated with death in severe sepsis with MODS.
