摘要
目的探讨儿童脓毒症患者发生多器官功能障碍综合征(MODS)的危险因素。方法收集2007年1-12月首都儿科研究所PICU病房的153例脓毒症患儿,按照是否发生MODS,将患儿分为MODS组(n=28)和非MODS组(n=125)。观察2组患儿年龄、性别、PICU住院时间、慢性病史,确诊脓毒症24h内体温、呼吸、心率、收缩压、WBC计数、血细胞比容、PLT计数、血糖、血钠、血钾、肌酐、肝酶、总胆红素、LDH、动脉血气、CRP、降钙素原(PCT)、凝血功能、脓毒症的原发感染部位、细菌培养情况、确诊前后手术情况、小儿危重病例评分(PCIS)、改良Glasgow昏迷评分、呼吸机治疗率及预后。应用SPSS17.0软件对以上指标进行单因素分析和Logistic回归多因素分析。结果PICU脓毒症发病率为33.3%,病死率为8.5%。PICU中MODS发病率为18.3%,病死率为39.3%。2个、3个及3个以上脏器受累MODS患儿病死率分别为11.1%、41.7%和71.4%。呼吸道感染是脓毒症最常见的原发感染灶(73.2%),中枢神经系统感染患儿病死率最高(8.30%)。细菌是儿童脓毒症最主要病原,以葡萄球菌感染最多见。单因素分析显示,慢性病史、心率、WBC计数、PLT计数、PCT、血糖、血钠、血肌酐、尿素氮、肝酶、LDH、清蛋白、血气、D-二聚体、Glasgow评分、PCIS、机械通气时间,MODS组与非MODS组间比较差异均具有统计学意义;多因素Logistic回归分析显示PCIS评分、ALT及机械通气时间对发生MODS有显著影响。结论PCIS、ALT、机械通气时间可作为脓毒症患儿发生MODS的独立危险因素。
Objective To explore the risk factors of childhood multiple organ dysfunction syndrome（MODS）caused by sepsis.Methods Clinical data of 153 patients with sepsis in Pediatric Intensive Care Unit（PICU）of Capital Institute of Pediatrics,from Jan.to Dec.2007 were retrospectively reviewed.The patients were divided into MODS group and non-MODS group.The age,sex,time of hospitalization,chronic disease,the worst value in the first 24 hours after sepsis of temperature,respiratory rate,heart rate,systolic pressure,white blood cell count,hematocrit,platelet count,blood glucose,blood sodium,blood potassium,creatinine,liver enzyme,total bilirubin,lactate dehydrogenase,blood gas,C-reactive protein（CRP）,procalcitonin（PCT）,cruor function,the original site of infection,organism,surgery,Glasgow coma score,pediatric critical illness score（PCIS）,time of mechanical ventilation and prognosis of patients in 2 groups were observed.Univariate analysis and multivariate logistic analysis were conducted for possible influencing factors.Results The morbidity and the mortality of sepsis and MODS were 33.3%,8.5%,and 18.3%,39.3% in PICU,respectively.The mortality were 11.1%,41.7% and 71.4% respectively in patients with 2,3 or more organ function failure.The majority of infection causing sepsis was respiratory system infection（73.2%）.The most deadly infection was the central nervous system infections（8.3%）.Bacteria was the predominant organisms causing pediatric sepsis.Staphylococcus was most common.In the univariate analysis,variables significantly associated with onset in MODS were chronic disease,heart rate,white blood cell count,platelet count,PCT,blood glucose,blood sodium,serum creatinine,urea nitrogen,liver enzyme,lactate dehydrogenase,albumin,blood gas,D-dimer,Glasgow coma score,PCIS and time of mechanical ventilation.In the Logistic regression model,the variables significantly associated with MODS were PCIS,ALT and time of mechanical ventilation.Conclusion PCIS,ALT and time of mechanical ventilation can predict the occurrence of MODS.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2010年第6期398-401,共4页
Journal of Applied Clinical Pediatrics
基金
北京市青年科学研究项目(QN2009-023)
