PICU婴儿脓毒症及严重脓毒症临床特征及预后危险因素分析  

Sepsis and severe sepsis in PICU infant： analysis of risk factors and clinical feature

作　　者：李璧如[1] 安康[1] 曹清 赵醴[1] 钱娟[1] 王莹[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心,200127

出　　处：《中国小儿急救医学》2013年第6期595-598,共4页Chinese Pediatric Emergency Medicine

基　　金：国家自然科学青年基金（81201450）

摘　　要：目的 分析PICU婴儿脓毒症、严重脓毒症的临床特征,探讨影响其预后的危险因素.方法 对2006年1月至2011年12月我院PICU收治的141例脓毒症患儿运用回顾性病例对照（存活组与死亡组）的研究策略,以患儿入院日为研究起点,死亡或出院为终点,进行临床特点分析.并选择性别、年龄、是否有基础疾病、脓毒症严重程度、脏器受累数、入PICU当天的危重病评分、血生化指标（乳酸、白蛋白、血糖）、血气指标（碱剩余、碳酸氢根、pH值）、是否休克、培养阳性等14个变量,建立Logistic回归模型,分析预后的危险因素.结果 141例患儿的年龄1～12个月,其中脓毒症72例,严重脓毒症69例,死亡29例,病死率为20.6％.29例死亡患儿中,13例有基础疾病.脓毒症和严重脓毒症患儿的感染部位均以肺部为主,分别占47.2％（34/72）、47.8％（33/69）;血培养均有34例阳性,分别占47.2％ （34/72）、49.3％ （34/69）.单因素分析显示,性别、基础疾病、年龄、脓毒症严重程度、休克、脏器受累数、危重病例评分、血乳酸、血气pH值、碱剩余、碳酸氢根与脓毒症死亡有关.经逐步引入剔除法,建立Logistic回归模型,仍然与死亡相关的因素包括脓毒症严重程度（OR=22.5,95％CI=5.089,99.475）和脏器受累数（OR=3.305,95％CI=2.152,5.075）.结论 婴儿脓毒症严重程度越重和器官受累数越多,死亡风险越大.Objective To analyze the clinical characteristics of PICU infant with sepsis,severe sepsis,and to explore the impact of prognostic factors.Methods We conducted a retrospective study of 141 cases （from January 2006 to December 2011） who were diagnosed as sepsis and severe sepsis to identify the clinical characteristics.There were 14 variables of the PICU admission day which concluded gender,age,underlying diseases,sepsis severity,organ involvement,critical score,blood biochemistry （lactate,albumin,glucose）,blood gas （base excess,bicarbonate,pH）,shock,culture-positive.The death or discharge as the outcome factor.The data were analyzed with the Logistic regression model.Results One hundred and forty-one cases aged from 1 to 12 months,of which 72 cases were sepsis and 69 cases were severe sepsis,29 cases died with the mortality of 20.6％.In 29 death children,13 cases had underlying diseases.In children with sepsis and severe sepsis,the most common infection site was lung,accounting for 47.2％ （34/72） and 47.8％ （33/69） ;blood cultures were positive for 34 cases,accounting for 47.2％ （34/72） and 49.3％ （34/69）.Variables in the univariate analysis those were significantly associated with death from sepsis were gender,underlying diseases,age,sepsis severity,shock,organ involvement,the number of critical illness score,blood lactate,base excess,bicarbonate and pH.In the Logistic regression model,the variables significantly associated with death were the severity of sepsis （OR =22.5,95 ％ CI =5.089,99.475）,and the number of organ involvement （OR=3.305,95％CI=2.152,5.075）.Conclusion The heavier sepsis severity and the more number of organ involvement are,the greater the risk of death will be.

关 键 词：脓毒症 严重脓毒症 预后 婴儿 

分 类 号：R720.597[医药卫生—急诊医学]