PICU中儿童脓毒症临床特点和预后相关因素分析

摘要

目的 探讨PICU中无基础疾病脓毒症患儿的临床特点及预后相关因素.方法 回顾2014年2月至2016年6月PICU收治的110例无基础疾病的脓毒症患儿临床资料.根据脓毒症严重程度将患儿分为脓毒症组、严重脓毒症组、脓毒性休克组,根据PICU入住28 天时的预后情况将患儿分为存活组、死亡组;比较各组间的差异.结果 110例无基础疾病的脓毒症患儿中,男74例、女36例,中位年龄0.42岁.肺部感染为主要感染源.总病死率为14.55%.脓毒症、严重脓毒症、脓毒性休克患儿的病死率分别为2.94 %、27.27 %、35.48 %,差异有统计学意义(P<0.001);三组间降钙素原(PCT)、白细胞计数(WBC)、肌酐(Cr)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、器官功能障碍(MODS)数目、小儿危重病例评分(PCIS)、小儿多器官功能障碍评分(P-MODS)、6 h内机械通气、机械通气时间、28 天预后的差异均有统计学意义(P<0.05).存活与死亡患儿比较,PCT、乳酸(Lac)、APTT、INR、MODS数目、PCIS、P-MODS、6 h内机械通气、机械通气时间、住PICU时间、住院时间、脓毒症严重程度的差异均有统计学意义(P<0.05).Logistic回归分析提示,PCIS评分高、住院时间长,患儿28天预后好;而机械通气时间长,28天预后差(P<0.05).结论 PICU内无基础疾病的脓毒症患儿,PCT、WBC、Cr、APTT、INR、MODS数目、PCIS、P-MODS、6 h内机械通气、机械通气时间有助于判断病情严重程度;PCIS、机械通气时间、住院时间影响预后.%Objective To explore the clinical features and prognostic factors of sepsis in children without underlying diseases in pediatric intensive care unit (PICU). Methods The clinical data of 110 children with sepsis who had no underlying diseases and were hospitalized in PICU from February 2014 to June 2016 were reviewed. According to the severity of sepsis, the children were divided into sepsis group, severe sepsis group, and septic shock group. According to the prognosis on 28 d after hospitalized in PICU, the children were divided into survival group and death group. The differences among different groups were compared. Results In 110 children with sepsis and no underlying diseases (74 males and 36 females) a median age was 0.42 years. Pulmonary infection is the main source of infection. The overall mortality rate was 14.55%. The mortality rates of sepsis, severe sepsis, and septic shock were 2.94%, 27.27%, and 35.48% respectively, and the difference was statistically significant (P<0.001). The difference in procalcitonin (PCT), white blood cell (WBC), creatinine (Cr), activated partial thromboplastin time (APTT), international normalized ratio (INR), multiple organ dysfunction (MODS), the pediatric critical illness score (PCIS), pediatric multiple organ dysfunction score (P-MODS), mechanical ventilation within 6 h, the duration of mechanical ventilation and the prognosis on 28 days were statistically among those three groups (P all<0.05). The difference in level of PCT, lactic acid (Lac), APTT, INR, MODS, PCIS, P-MODS, mechanical ventilation within 6 h, the duration of mechanical ventilation, PICU stay time, hospitalized time, the severity of sepsis were statistically different (P all<0.05) between survival group and death group. Logistic regression analysis showed that children with higher PCIS and longer hospitalized time had a better prognosis on 28 d, while those with longer mechanical ventilation had a poorer prognosis on 28 d (P<0.05). Conclusions The levels of PCT, WBC, Cr, APTT, INR, MODS, PCIS, PCT, P-MODS, 6 h mechanical ventilation, and mechanical ventilation time were helpful in determining the severity of sepsis in children without underlying diseases hospitalized in PICU. PCIS, mechanical ventilation time, and hospitalized time affect prognosis.