摘要
目的探讨侵袭性肺炎链球菌性疾病(IPD)所致脓毒性休克的临床特点,并分析其预后的影响因素。方法回顾性研究2015年1月至2020年12月嘉兴市第二医院收治的IPD所致的脓毒性休克患儿42例的临床资料,分析其临床特点以及预后情况。结果42例患儿中,年龄为1.3(0.75,4.15)岁。第二代儿童死亡分析指数(PIM-2)为(23.38±9.26)分。感染部位主要为血液和颅内。18例对青霉素敏感,20例对头孢吡肟敏感,22例对头孢噻肟敏感,20例对美罗培南敏感,对万古霉素以及利奈唑胺均敏感。42例患儿病死率为61.90%(26/42)。死亡组患儿PIM-2[(37.17±10.58)分比(0.92±0.39)分,t=17.45,P<0.001]以及颅内高压危象率(69.23%比25.03%,χ^(2)=7.77,P=0.005)显著高于存活组,胸腔感染率显著低于存活组(7.69%比50.00%)(P<0.05)。结论IPD所致脓毒性休克患儿多以小年龄为主,且感染部位以颅内和血流最为常见,同时对于头孢类药物以及青霉素耐药率高,颅内高压危象致死率高,应尽早识别和治疗。
Objective To investigate the clinical characteristics of septic shock caused by an invasive pneumococcal disease(IPD)and analyze the factors that affect the prognosis of this disease.Methods We retrospectively analyzed the clinical data of 42 children with an IPD-caused septic shock,who received treatment in The Second Hospital of Jiaxing from January 2015 to December 2020,and evaluated the clinical characteristics and prognosis of this disease.Results The age of the included children averaged 1.3(0.75,4.15)years.The Pediatric Index of Mortality 2 was(23.38±9.26)points.Infections were primarily in the blood and brain.Eighteen cases were sensitive to penicillin,20 cases to cefepime,22 cases to cefotaxime,and 20 cases to meropenem,vancomycin,and linezolid simultaneously.The mortality was 61.90%(26/42).The Pediatric Index of Mortality 2[(37.17±10.58)points vs.(0.92±0.39)points,t=17.45,P<0.001],and the rate of children developing an intracranial hypertension crisis(69.23%vs.25.03%)(χ^(2)=7.77,P=0.05)were significantly higher in the death group than in the survival group.Compared with the survival group,the thoracic infection rate was significantly lower in the death group(7.69%vs.50.00%,P<0.05).Conclusion Most children with an IPD-caused septic shock are young,and most infection sites are in the brain and blood.The IPD-caused septic shock is highly resistant to cephalosporins and penicillin and has high mortality because of an intracranial hypertension crisis.The IPD-caused septic shock should be screened and treated as early as possible.
作者
王华
张旭
应勤来
余伟杰
Wang Hua;Zhang Xu;Ying Qinlai;Yu Weijie(Department of Pediatrics,The Second Hospital of Jiaxing,Jiaxing 314000,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2022年第4期530-533,共4页
Chinese Journal of Primary Medicine and Pharmacy
关键词
休克
脓毒性
链球菌
肺炎
C反应蛋白质
原降钙素
Shock,septic
Streptococcus pneumoniae
C-reactive protein
Procalcitonin
