摘要
目的分析以胃肠道感染起病的小儿脓毒性休克及多器官功能障碍综合征衰竭(MODS MOF)的临床特征、病因及转归。方法总结2000年1月至2004年12月收治的28例患儿,在胃肠道感染发病后,发生脓毒性休克及MODS MOF的临床特征、死亡影响因素。结果28例患儿中,21例死亡,病死率为75%。年龄(1.9±3.4)岁,19例(67.8%)小于1岁。累及(3.7±0.9)个器官,发病至出现首个系统或器官功能障碍时间为(39.4±24)h。受累脏器频度依次为循环系统28例(100%)、胃肠道21例(75%)、肺20例(71.4%)、肾14例(50%)、脑9例(32.4%)、血液9例(32.4%)、肝5例(17.9%)。最早出现障碍的器官分别是胃肠道13例(46.4%),循环系统11例(39.3%),肺4例(14.3%)。容量复苏1h内液量30～75ml kg,(46.2±12.6)ml kg;6h内输液量70～120ml kg,(92.7±33.9)ml kg。6h内达到和未达复苏目标(EGDT)者病死率分别为66.7%和90.0%。合并器官衰竭数目和危重评分值与病死关系有显著性(P<0.05或P<0.01)。结论小儿源于胃肠道感染后的MODS MOF,发病年龄小,病情进展迅速,病死率高;容量复苏液体需要量大,6h达到复苏目的者预后较好。
Objective To study the etiology, clinical features, risk factors of septic shock and multiple organ dysfunction syndrome/multiple organ failure （MODS/MOF） caused by gastroenteritis infection in the pediatric intensive care unit （PICU）. Methods Case records of patients with gastroenteritis complicated by septic shock and MODS/MOF admitted to PICU in Children＇s hospital affiliated to Shanghai Jiaotong University from January 2000 to December 2004 were reviewed for etiology, case fatality rate, prognosis and relationship with MODS/MOF. Univariate analyses were performed to analyse the risk factors associated with septic shock and MODS/MOF. Results During the 5 years, 1 536 patients with critical illness were admitted and MODS/MOF associated with gastroenteriitis infection developed in 28 patients. The overall mortality of patients with MODS/MOF associated with gastroenteriitis was 75%. The mean age was （1.9 ± 3.4） years and 19 cases （67.8%） were under 1 year. The patients with MODS/MOF involved （3.7 ± 0.9） organs or systems on average. The numbers of involved organs systems were circulatory in 28 patients （ 100% ）, gastrointestinal system in 21 （75%）, lung in 20 （71.4%）, kidney in 14 （50%）, brain in 9 （32.4%）, blood in 9 （32.4%） and liver in 5 （17.9%）. The first dysfunctional system was gastrointestinal tract in 13 （46.4%）, cireulatury in 11 （39.3%）, and lung in 4 （ 14.3% ）. The average volume of fluid resuscitation was （46.2 ± 12.6） ml/kg and range from 30 ml/kg to 75 ml/kg in the first hour. The average fluid was （92.7 ± 33.9） ml/kg and range from 70 ml/kg to 120 ml/kg in 6 hours. The cases fatality of patients with or without successful volume resuscitation were 66.7% （ 12 in 18 cases） and 90% （9 in 10 cases） in 6 hours respectively. Univariate analyses indicated the following risk factors： numbers of failed organ and lower pediatric critical illness score （ P〈0.05 or P〈0.01 ）. Conclusion The patients with MODS/MOF associated with gastroenteritis infection in children had the following features： The events occurred in young age and most commonly in infancy. The disease progression was rapid the with poor outcome and higher mortality rate. The volume required for resuscitation was more than usual. The lower eases fatality might be possible in patients with successful volume resuscitation in 6 hours.
出处
《中华急诊医学杂志》
CAS
CSCD
2006年第6期494-497,共4页
Chinese Journal of Emergency Medicine
关键词
感染
胃肠道
休克
多器官功能障碍
衰竭
儿童
Infection
Gastrointestinal tract
Septic shock
Multiple organ dysfunction syndrome
Multiple organfailure
Child
作者简介
通讯作者：张宇鸣 电话：021—62474880
