摘要
目的了解儿童脓毒症的生存情况,探讨影响其预后的相关因素。方法回顾性分析205例脓毒症患儿的临床资料,包括性别、年龄、90 d内生存情况等。结果 90 d生存率78.0%(Life Table法),发病后7～25 d死亡风险最高。死亡患儿并发脓毒性休克(shock)、急性肺损伤(ALI)/呼吸窘迫综合征(ARDS)和多器官功能障碍(MODS)的比例高于存活患儿,差异有统计学意义(P<0.05);死亡患儿的年龄、入PICU时及最危重时的儿童危重病例评分(PCIS)、收缩压(SBP)、舒张压(DBP)、血清白蛋白(ALB)和血小板计数(PLT)均低于存活患儿,而机械通气治疗时间长于存活患儿,差异均有统计学意义(P<0.05)。入选死亡因素多元Cox比例风险回归方程的变量为年龄(RR=0.426)、MODS(RR=4.732)、ALI/ARDS(RR=4.269)、最危重时的PCIS(RR=0.186)、机械通气时间(RR=0.159)和ALB(RR=0.507)。方程的受试者工作特征曲线(ROC)下面积为0.847(95%CI:0.787～0.908),判定死亡的灵敏度91.30%,特异度65.40%,一致率71.22%(Kappa=0.146,P=0.001)。结论儿童脓毒症病死率高,年龄、MODS、ALI/ARDS、最危重时PCIS和ALB是影响其预后的强相关因素。
Objective To understand the survival of pediatric patients with sepsis, and to explore the impact factors of prognosis. Methods The clinical records of 205 pediatric patients with sepsis were retrospectively reviewed. Results The 90 d overall survival rate was 78.0%. The peak risk of death appeared from 7 to 25 clays after sepsis onset. Compared with survival patients, complications such as septic shock, acute lung injury （ALI） /acute respiratory distress syndrome （ARDS）, multiple organ dysfunction syndrome （MODS） were significantly more in deceased patients （P 〈 0.05）. Age, the pediatric critical illness scores （PCIS） at into PICU and at the most critical time, SBP, DBP, serum albumin （ALB） and platelet count （PLT） were significantly lower in deceased patients that those in survived patients （P 〈 0.05 ） ; mechanical ventilation time was significantly longer in death patients than that in survived patients （P 〈 0.05）. The variables entered into the multivariable Cox proportional hazard regression equation were age （RR = 0.426）, MODS （RR = 4.732）, ALI/ARDS （RR = 4.269）, PCIS at most critical time （RR = 0.186）, mechanical ventilation time （RR = 0.159） and ALB （RR = 0.507）. The area under the ROC curve was 0.847 （95%CI： 0.787 - 0.908）. The sensitivity, specificity, and accuracy rate for prediction of death were 91.30%, 65.40%, and 71.22%, respectively. Conclusions The mortality of pediatric patients with sepsis was high. Age, MODS, ALI/ARDS, PCIS at most critical time, and ALB are the independent factors influencing prognosis.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2012年第1期18-21,共4页
Journal of Clinical Pediatrics
关键词
脓毒症
生存分析
相关因素
儿童
sepsis
survival analysis
relevant factor
child
