摘要
目的探讨儿童脓毒性休克的流行病学特点及预后影响因素。方法采用回顾性研究方法,收集2017年1月至2020年7月广西壮族自治区妇幼保健院PICU收治的90例脓毒性休克患儿的临床资料,采用Logistic回归分析的统计方法,对儿童脓毒性休克的流行病学特点及死亡危险因素进行分析。结果90例脓毒性休克患儿中,死亡27例,病死率30.0%,原发感染部位主要为肺部和胃肠道/腹腔,其中原发胃肠道/腹腔感染致脓毒性休克患儿的病死率高于原发肺部感染患儿(48.1%比23.7%,χ^(2)=6.049,P<0.05),死亡时间短于原发肺部感染患儿[2.1(0.9,6.5)d比8.0(2.2,13.5)d,H=2.052,P<0.05]。以患儿的预后为因变量,将性别、年龄、小儿危重病例评分、格拉斯哥昏迷评分、低血压、是否合并基础疾病、高乳酸血症、重症肺炎、胃肠功能衰竭、肝功能衰竭、急性肾损伤、应激性高血糖引入Logistic回归方程,小儿危重病例评分、低血压、合并基础疾病、胃肠功能衰竭、肝功能衰竭、急性肾损伤均与儿童脓毒性休克预后相关,其中低血压、胃肠功能衰竭及合并基础疾病为脓毒性休克患儿病死的独立危险因素。结论对原发胃肠道/腹腔感染、合并基础疾病及代偿期的脓毒性休克患儿,需早期加强干预。
Objective To explore the epidemiological characteristics of septic shock in children and analyse the risk factors for prognosis.Methods Retrospective study was conducted to collect the clinical data of 90 children with septic shock admitted to PICU from January 2017 to July 2020.Logistic regression analysis was used to analyze the epidemiological characteristics and risk factors of death of children with septic shock.Results Among the 90 children with septic shock,27 patients died,with a fatality rate of 30.0%.The primary infection sites were mainly in lungs and gastrointestinal/abdominal cavity,and the mortality rate of children with septic shock caused by primary gastrointestinal/abdominal infection was higher than that of lungs infection(48.1%vs.23.7%,χ^(2)=6.049,P<0.05),and the time of death was shorter than that of lungs infection[2.1(0.9,6.5)d vs.8.0(2.2,13.5)d,H=2.052,P<0.05].With the prognosis of children as dependent variable,the sex,age,pediatric critical illness score,glasgow coma scale,hypotension,combination with basic diseases,high lactic acidosis as well as severe pneumonia,gastrointestinal function failure,liver failure,acute kidney injury,and stress hyperglycemia were introduced to Logistic regression equation.The results showed that pediatric critical illness score,hypotension,combination with basic diseases,gastrointestinal function failure,liver failure,and acute kidney injury were related to the prognosis of children with septic shock,and hypotension,gastrointestinal function failure and combination with basic diseases were independent risk factors for death in children with septic shock.Conclusion It is necessary to strengthen early intervention for primary gastrointestinal/abdominal infection,combined with underlying diseases and septic shock in compensatory stage.
作者
韦跃
谢友军
韦蓉
唐育鹏
莫武桂
Wei Yue;Xie Youjun;Wei Rong;Tang Yupeng;Mo Wugui(Department of Prevention and Health Care,Guangxi Maternity and Child Health Hospital,Nanning 530000,China;Department of Critical Care Medicine,Guangxi Maternity and Child Health Hospital,Nanning 530000,China)
出处
《中国小儿急救医学》
CAS
2021年第9期769-772,共4页
Chinese Pediatric Emergency Medicine
基金
广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20170786)。
作者简介
通信作者:谢友军,Email:xieyoujun55@163.com。
