摘要
目的总结严重脓毒症的临床特征,探讨严重脓毒症死亡的危险因素,以利于临床对该病的早期认识,提高严重脓毒症的抢救成功率.方法对2014年8月~2018年5月于我院儿童重症监护室(pediatric intensive care unit,PICU)确诊为严重脓毒症的83例患儿进行回顾性分析,记录患儿严重脓毒症的发流行病学等共24个因素.同时运用单因素分析和Logistic回归分析对因素进行分析,了解儿童严重脓毒症死亡的独立危险因素.结果 83例患儿,死亡20例,病死率24.09%;其中脓毒性休克37例,机械通气41例,合并1、2、3个及以上脏器功能障碍者病死率分别为2.1%(1/47)、17.6%(3/17)、84.2%(16/19).原发病以肺炎、中枢神经系统感染及消化系统疾病为主,呼吸系统疾病居严重脓毒症死亡原发病首位.单因素分析显示,低血压、机械通气、血乳酸值、血红蛋白、血清总蛋白(total protein,TP)、血清白蛋白(albumin,ALB)、多脏器功能不全综合征(multiple organ dysfunction syndrome,MODS)受累脏器数、小儿危重病例(PCIS)评分与严重脓毒症死亡相关.将单因素分析结果中有统计学意义的8个影响因素进行多因素条件Logistic回归分析,结果显示仍然有血清乳酸值、PCIS评分及MODS受累脏器数3个影响因素与死亡有关(P<0.05).结论儿童严重脓毒症病死率高,血清乳酸增高、PCIS评分低和MODS是疾病死亡的独立危险因素.
Objective To summarize the clinical features of severe sepsis and to explore the risk factors of severe sepsis death, in order to facilitate the early understanding of the disease and improve the rescue success rate of severe sepsis. Methods A total of 83 children diagnosed with severe sepsis from August 2014 to May 2018 in the pediatric intensive care unit (PICU) af our hospital were retrospectively analyzed. The 24 factors including the prevalence of severe sepsis in children were recorded. At the same time, the factors were analyzed by univariate analysis and Logistic regression analysis. The independent risk factors of severe sepsis death in children were analyzed. Results Of the 83 children, 20 cases died and the mortality rate was 24.09%. Among them, 37 cases had septic shock and 41 cases underwent mechanical ventilation. The mortality rate of 1, 2, 3 or more organ dysfunction was 2.1%(1/47), 17.6%(3/17) and 84.2%(16/19). The primary diseases were mainly pneumonia, central nervous system infection and digestive system diseases, and respiratory diseases were the first cause of serious sepsis death. Univariate analysis showed that hypotension, mechanical ventilation, blood lactate, hemoglobin, total protein(TP), serum albumin (albumin, ALB), the number of organs affected by multiple organ dysfunction syndrome(MODS), and the pediatric critically ill(PCIS) score were associated with severe sepsis death. Multivariate conditional Logistic regression analysis of the eight influential factors in the univariate analysis showed that there were still three factors affecting death, including serum lactate value, PCIS score and number of organs affected by MODS (P<0.05). Conclusion Children with severe sepsis have a high mortality rate. High serum lactate, low PCIS score and MODS are independent risk factors for disease death.
作者
陈春芳
阳斌
曹宁丽
林峰
CHEN Chunfang;YANG Bin;CAO Ningli;LIN Feng(Department of Pediatrics,Jiujiang Maternal and Child Health Hospital in Jiangxi Province,Jiujiang 332000,China)
出处
《中国现代医生》
2019年第27期75-78,共4页
China Modern Doctor
关键词
儿童
严重脓毒症
临床特征
危险因素
Children
Severe sepsis
Clinical features
Risk factors
