血液系统恶性肿瘤合并脓毒症患儿的临床特点及死亡因素分析  

The clinical characteristics and risk factors for death of sepsis children with hematologic malignancy

作　　者：史柳红[1] 杨燕文[1] 钱娟[1] 任宏[1] 李壁如[1] 王莹[1] 

机构地区：[1]上海交通大学医学院附属儿童医学中心,上海200127

出　　处：《临床儿科杂志》2012年第1期10-14,共5页Journal of Clinical Pediatrics

摘　　要：目的血液系统恶性肿瘤合并脓毒症是儿科重症监护病房患儿死亡的重要原因之一。探寻其临床特点以及相关的死亡危险因素,有助于临床早期识别、诊断以及治疗。方法对血液系统恶性肿瘤合并脓毒症患儿进行临床特征的回顾性调查分析,并对其中严重脓毒症死亡患儿的危险因素进行Logistic回归分析。结果 36例血液系统恶性肿瘤合并脓毒症患儿中7例为脓毒症,29例为严重脓毒症。脓毒症与严重脓毒症患儿比较,小儿危重病例评分(PCIS)、碱剩余(BE)的差异有统计学意义(P均<0.05)。血液系统恶性肿瘤患儿合并脓毒症时,休克发生率高达80.56%;严重脓毒症患儿的病死率达58.62%。多因素Logistic回归分析结果显示与严重脓毒症患儿死亡相关变量为多器官功能障碍(MODS)受累脏器数、机械通气时间。结论血液系统恶性肿瘤患儿合并脓毒症时,PCIS和BE值有助于判断病情和预后。血液系统恶性肿瘤患儿合并脓毒症的休克发生率高、病死率高,MODS受累脏器数、机械通气时间是其死亡的危险因素。Objective Hematologic malignancy combined sepsis is one of major causes of death in pediatric intensive care unit. To clarify the clinical characteristics and to investigate the death risk factors for early identification, diagnosis and proper therapy for pediatric patients of hematologic malignancy with sepsis. Methods Retrospectively analysis of the clinical features of pediatric patients of hematologic malignancy with sepsis. Analysis the risks for death of pediatric patients with severe sepsis. Results Clinical data had been collected from 36 pediatric patients of hematological malignancies with sepsis, 7 patients having sepsis and 29 patients having severe sepsis. The pediatric critical illness score （PCIS） and base excess （BE） level were significantly different between sepsis and severe sepsis patients （P 〈 0.05）. The incidence of shock was high （80.56%） in pediatric patients of hematological malignancies with sepsis. The mortality was high （58.62%） in severe sepsis patients. The related death risk factors in severe sepsis patients were the number of involved organs in multiple organ dysfunctions, the duration of mechanical ventilation by Logistical regression analysis. Conclusions Once in pediatric patients with hematology malignancy had sepsis, PCIS and BE level could help determine the condition and prognosis. The pediatric patients of hematologic malignancy with sepsis had high incidence of shock and mortality. The risk factors for death were the number of involved organs in muhiple organ dysfunctions and the duration of mechanical ventilation.

关 键 词：血液肿瘤 脓毒症 儿童 

分 类 号：R733[医药卫生—肿瘤] R720.597[医药卫生—临床医学]