摘要
目的：分析重症患儿高淀粉酶血症的临床特点，探讨重症患儿高淀粉酶血症发生及预后的相关危险因素，以便为临床预防和治疗提供依据。方法分析2011年4月至2012年10月湖南省儿童医院儿科重症监护室（PICU）收治的1036例重症患儿，将其分为高淀粉酶血症组（82例），非高淀粉酶血症组（954例），并根据预后将高淀粉酶血症组分为存活组（61例）和死亡组（21例），采用单因素和多因素Logistic回归方法分析影响患儿高淀粉酶血症的发生和预后的危险因素。结果高淀粉酶血症组和非高淀粉酶血症组之间凝血功能障碍、抽搐、意识功能障碍、小儿危重病例评分（PCIS）PCIS≤80分、多器官功能障碍（MODS）MODS≥3个、脓毒症、休克、乳酸（LA）、降钙素原（PCT）、血糖（BG）的差异具有统计学意义（P＜0.05）。存活组和死亡组之间凝血功能障碍、抽搐、机械通气、PCIS≤80分、MODS≥3个、休克、LA、PCT、氧合指数、白蛋白、C肽、血糖的差异具有统计学意义（P＜0.05）。多因素 Logistic 回归分析显示，LA （OR＝1.662，95％CI：1.236～2.234）、PCT （OR＝1.042，95％CI：1.025～1.060）、BG （OR＝1.612，95％CI：1.411～1.843）、PCIS≤80分（OR ＝3.219，95％CI：1.311～7.905）、MODS≥3个（OR＝3.411，95％CI：1.370～8.494）是影响患儿高淀粉酶血症发生与否的危险因素。PCT （OR＝1.066，95％ CI：1.021～1.113）、C肽（OR＝1.437，95％CI：1.017～2.030）、PCIS≤80分（OR ＝16.137，95％ CI：1.876～138.836）、MODS≥3个（OR ＝10.437，95％ CI：1.528～71.925）、休克（OR＝20.928，95％ CI：1.938～226.009）是影响高淀粉酶血症患儿预后的危险因素。结论重症患儿病情越危重、伴高LA、高PCT、高BG，以及合并器官衰竭数目越多则越易发生高淀粉酶血症；高淀粉酶血症患儿病情越危重、合并器官衰竭数目越多、伴高PCT、高C肽及休克则患儿预后越差。
Objective To analyze the clinical features of the hyperamylasemia in critically ill children and investigate the related risk factors in order to provide the basis for prevention and treatment. Methods A total of 1036 critically ill children admitted in pediatric intensive care unit （PICU）from April,2011 to Oct,2012 were studied.They were divided into the high amylase group （n=82）and the normal group （n=954）.According to the outcomes,the high amylase group was divided into survival group （n=61 ） and death group （n =21 ）.The related risk factors of the occurrence and outcome of hyperamylasemia were analyzed by univariate and multivariate Logistic regression.Results There were statistically significant differences in rates of coagulation disorders, convulsions, disturbance of consciousness,pediatric critical illness score （PCIS）≤80,multiple organ dysfunction （MODS）≥3, sepsis,shock,and lactic acid （LA）,procalcitonin （PCT）,blood glucose （BG）between the high amylase group and the normal group （P〈0.05 ）.The differences in the rates of coagulation disorders,convulsions, mechanical ventilation,PCIS≤80,MODS≥3,and LA,PCT,oxygenation index,albumin,C-peptide,BG were statistically significant between the survival group and the death group （P 〈0.05 ）.Multivariate Logistic regression analysis showed that the risk factors of the hyperamylasemia＆#39;s occurrence were LA,PCT, BG,PCIS〈80,MODS〉3.Adjusted ORs confidence intervals of them were 1.662 （1.236-2.234）,1.042 （1.025-1.060）,1.612 （1.411-1.843）,3.219 （1.311-7.905）,3.411 （1.370-8.494）,respectively. The hyperamylasemia＆#39;s prognostic risk factors were PCT,C-peptide,PCIS ≤80,MODS 〉3,shock. Adjusted ORs confidence intervals of them were 1.066（1.021-1.113）,1.437（1.017 -2.030）,16.137 （1.876-138.836）,10.437（1.528-71.925）,20.928（1.938-226.009）,respectively.Conclusions The severity of the disease,the levels of LA,PCT,BG in critically ill children were positively correlated to the occurrence of hyperamylasemia.The severity of the disease,the incidence of organ failures,the levels of PCT,C-peptide combined shock in children with hyperamylasemia were positively correlated to the prognosis of hyperamylasemia.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2014年第6期620-624,共5页
Chinese Journal of Emergency Medicine
关键词
高淀粉酶血症
危险因素
儿童
重症
预后
脓毒症
高血糖
胰腺损伤
Hyperamylasemia
Risk factors
Children
Critically ill
Prognosis
Sepsis
Hyperglycemia
Pancreatic injury
