摘要
目的探讨儿童脓毒症中细菌性及病毒性感染的临床特征,达到早识别、快速有效的抗菌生素治疗和改善预后的目的。方法收集2019年1月到2021年12月本院重症医学科收治的142例1月龄~14岁病原学明确、临床资料完整且诊断脓毒症的患儿作为研究对象,排除本次发病前存在其他基础性疾病及24h内出院或者死亡的病例,其中细菌感染84例(甲组),病毒感染58例(乙组),对比分析细菌性脓毒症的临床特征、急性炎性反应蛋白水平、器官功能、血流动力学指标、住ICU时间、机械通气时间、治疗存活者脑损伤后遗症发生率、未愈病死率差异。结果甲组较乙组相同发热温度时心率更快、发绀表现多、毛细血管再充盈时间(CRT)长,血红蛋白(HB)低,C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、降钙素原(PCT)、B型钠尿肽前体(BNP)、血糖更高,小儿危重病例评分(pediatric critical illness score,PCIS)低,病情更重,液体容量不足出现少,机械通气时间短,存活者脑损伤后遗症少。乙组中有心肺复苏、严重脑损伤及多器官功能损害的8例患儿PCT大幅度增高(30ng/mL~100ng/mL)。两组血流动力学监测指标无统计学差异。结论紫绀、心率增快及CRT延长明显,CRP、PCT、SAA及血糖明显增高,提示细菌性脓毒症可能性大,有效抗感染治疗可降低脑损伤后遗症发生,改善生存质量。有心肺复苏史、严重脑损伤及多器官功能损害者PCT增高可能是器官损害,而并非细菌感染指标。
Objective To explore the clinical characteristics of bacterial versus viral infection in children with sepsis,so as to achieve the purpose of early identification,rapid and effective antibiotic treatment and the improved prognosis.Methods From January 2019 to December 2021,142 patients aged from1 month to 14 years with clear etiological and clinical data and complete diagnosis of sepsis were collected,excluding other basic diseases before onset,discharged or dead cases within24 hours,including 84 cases of bacterial infection(group A)and 58 cases of viral infection(group B).The clinical characteristics,acute inflammatory response protein level,organ function,hemodynamic indexes,ICU stay,mechanical ventilation time,the incidence of brain injury sequelae and nonhealing mortality of survivors were compared and analyzed.Results Compared with group B at the same fever temperature,group A had faster heart rate,more cyanosis,longer capillary refilling time(CRT),lower hemoglobin(HB),their C-reactive protein(CRP),serum amyloid A(SAA),procalcitonin(PCT),B-type natriuretic peptide precursor(BNP)and blood glucose being higher,pediatric critical illness score(PCIS)lower,condition more severe,fluid volume deficiency less and mechanical ventilation time shorter,survivors with less sequelae of brain injury.In group B,there were 8 children with cardiopulmonary resuscitation,severe brain injury and multiple organ function damage,and the PCT increased significantly(30ng/mL~100ng/mL).There was no significant difference in hemodynamic monitoring indexes between the two groups.Conclusions cyanosis,rapid heart rate and CRT length are obvious,CRP,PCT,SAA and blood glucose are significantly increased,suggesting a high possibility of bacterial sepsis.Effective anti infection treatment can reduce the sequelae of brain injury and improve the quality of life.The increase of PCT in patients with a history of cardiopulmonary resuscitation,severe brain injury and multiple organ function impairment may be an indicator of organ damage rather than
作者
郑劼
唐育鹏
李卓
莫武桂
Zheng Jie;Tang Yupeng;Li Zhuo;Mo Wugui
出处
《实用休克杂志（中英文）》
2023年第3期144-148,152,共6页
Journal of Practical Shock
关键词
儿童
细菌性脓毒症
临床特征
Children
Bacterial sepsis
Clinical characteristics
