摘要
目的 分析儿童重症监护病房中血液系统肿瘤与实体肿瘤患儿临床转归危险因素。方法 选取2016年8月~2020年9月天津市儿童医院重症监护病房(intensive care unit, ICU)收治的72例肿瘤患儿,根据肿瘤类别分为血液系统肿瘤组(49例)和实体肿瘤组(23例);根据是否合并脓毒症,分为脓毒症组(10例)和非脓毒症组(62例)。血液系统肿瘤化疗后合并脓毒症患儿要多于患实体肿瘤者,全部患者自入ICU开始随访至30天,随访终点为全因死亡,通过Cox回归分析合并脓毒症、合并急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)、合并多器官功能障碍综合征(multiple organ dysfunction syndrome, MODS)、C型反应性蛋白(C-type reactive protein, CRP)、尿素氮(urea nitrogen, BUN)、肌酐(creatinine, Cr)等指标对全因死亡的预测能力。分别对两组患者进一步进行Kaplan-Meier生存分析。通过受试者工作曲线(receiver operating characteristic curve, ROC)评价合并脓毒症、ARDS、MODS对全因死亡的预测能力。结果 合并脓毒症、ARDS、MODS是血液肿瘤和实体肿瘤患儿死亡的危险因素;Cox回归分析显示肿瘤患儿的预后与是否合并脓毒症(HR:6.255,95%CI:2.107~18.569)、ARDS(HR:2.935,95%CI:1.154~7.464)和MODS(HR:3.465,95%CI:1.437~8.352)有关,P均<0.05。合并脓毒症ROC曲线下面积是0.653(95%CI:0.520~0.786,P<0.05),合并ARDS ROC曲线下面积是0.620(95%CI:0.485~0.755,P=0.084)。结论 合并脓毒症、ARDS、MODS是肿瘤患儿死亡风险的主要原因,早期发现和及时诊断,并采取合理有效的综合措施可改善感染,降低病死率。
Objective To analyze the risk factors for clinical outcomes of hematological tumors and solid tumors in pediatric intensive care units.Methods A total of 72 children with tumor admitted to the Intensive Care Unit(ICU)of Tianjin Children’s Hospital from August 2016 to September 2020 were selected and divided into hematological tumor group(49 cases)and solid tumor group(23 cases)according to tumor types.According to the combination of sepsis,they were divided into the sepsis group(10 cases)and the non-sepsis group(62 cases).The children with sepsis after chemotherapy for hematological tumors were more than those with solid tumors.All patients were followed up 30 days after admission to ICU,and the end point of follow-up was all-cause death.Cox regression analysis was used to evaluate the predictive ability of sepsis,acute respiratory distress syndrome(ARDS),multiple organ dysfunction syndrome,(MODS),C-type reactive protein(CRP),urea nitrogen(BUN)and creatinine(Cr)for allcause death.Kaplan-Meier survival analysis was further performed in both groups.Receiver operating characteristic curve(ROC)was used to evaluate the predictive ability of sepsis,ARDS and MODS for all-cause death.Results Sepsis,ARDS and MODS were the risk factors for death of children with hematologic tumor and solid tumor.Cox regression analysis showed that the prognosis of children with tumor was associated with sepsis(HR:6.255,95%CI:2.107〜18.569),ARDS(HR:2.935,95%CI:1.154〜7.464)and MODS(HR:3.465,95%CI:1.437〜8.352)(P all<0.05).The areas under ROC curve for sepsis was 0.653(95%CI:0.520〜0.786,P<0.05),and the area under ROC curve of ARDS was 0.620(95%CI:0.485〜0.755,P=0.084).Conclusion Sepsis,ARDS and MODS are the main causes of death risk in children with tumor.Early detection and timely diagnosis,as well as reasonable and effective comprehensive measures can improve infection and reduce mortality.
作者
胡英伟
张瑄
王晓敏
李晓卿
HU Ying-wei;ZHANG Xuan;WANG Xiao-min;LI Xiao-qing(Department of Intensive Care Unit,Beichen Hospital District of Tianjin Children’s Hospital,Tianjin 300134,China;Graduate School,Tianjin Medical University,Tianjin 300070,China;General Ward for Chronic Diseases,Machang Hospital District of Tianjin Children's Hospital,Tianjin 300074,China)
出处
《哈尔滨医科大学学报》
CAS
2022年第1期42-46,共5页
Journal of Harbin Medical University
基金
天津卫计委科技基金(2015k2040)
