容量超负荷对严重脓毒症患儿死亡的预测价值  

Predictive value of fluid overload for mortality in children with severe sepsis

作　　者：陈娇[1] 项龙[1] 柏振江[1] 华军[1] 李莺[1] 李晓忠[2] 李艳红[2] 

机构地区：[1]苏州大学附属儿童医院重症监护室,215000 [2]苏州大学附属儿童医院肾脏科,215000

出　　处：《中华实用儿科临床杂志》2016年第10期755-759,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金（81370773）;江苏省自然科学基金（BK2012604）;江苏省高校研究生创新计划

摘　　要：目的探讨容量超负荷对严重脓毒症患儿死亡的预测价值。方法采用回顾性研究的方法，选择2011年1月至2015年3月入住苏州大学附属儿童医院重症监护病房（PICU）的严重脓毒症患儿，收集患儿入院72h容量负荷情况，并计算人院1h内儿童死亡指数Ⅱ（PIM2）评分。采用多因素Logistic回归分析评估容量负荷状态与死亡的关系，采用受试者工作特征曲线及曲线下面积（AUC）评估容量超负荷对死亡的预测价值。结果共纳入199例患儿，62例（31．2％）患儿死亡，其容量负荷的中位数为5．6％（3．7％一7．7％）。容量负荷百分比〈5％133例（66．8％），容量负荷百分比≥5％-10％55例（27．6％），容量负荷百分比≥10％11例（5．6％）。多因素回归分析显示容量负荷过重[比值比（oR）=1．263，95％置信区间（CI）：1．113～1．434，P〈0．001]，高PIM2评分（OR=1．028，95％CI：1．012～1．043，P〈0．001），多器官功能障碍综合征（OR=4．160，95％CI：1．728～10．012，P=0．001）是严重脓毒症患儿死亡的独立危险因素。在校正年龄和PIM2评分因素后，容量负荷的水平仍与病死率具有明显相关性（OR=1．309，95％CI：1．158～1．480，P〈0．001）。容量负荷预测严重脓毒症患儿死亡的AUC为0．741（95％CI：0．661～0．820，P〈0．001）。结论容量超负荷对严重脓毒症患儿的死亡有重要的预测价值。Objective To investigate the predictive value of fluid overload for mortality in children with severe sepsis. Methods In this retrospective study, the children with severe sepsis who were admitted to the Pediatric Inten- sive Care Unit （PICU）, Children＇s Hospital of Soochow University between January 2011 and March 2015. Fluid accu- mulation was calculated in the first 72 hours after admission. Pediatric index of mortality Ⅱ （PIM2） score was calcula- ted during the first 1 hour after admission. Multivariate Logistic regression analysis assessed the relationship between fluid overload and mortality after adjustment for confounding factors. The predictive value of fluid overload for mortality was assessed by the receiver operating characteristic curve and an area under the receiver - operating - characteristic curve （AUC）. Results Of the 199 children admitted,62 cases （31.2% ）died during PICU stay. Among the children, 133 cases （66.8%） had fluid overload of 〈 5% ,55 cases （27.6%）had fluid overload of≥5% -10% ,and 11 cases （ 5.6% ） had fluid overload of≥ 10%. Multivariate regression analysis showed that a high fluid overload percent （ OR = 1. 263,95 % CI：1.113 - 1. 434, P 〈 0.001 ）, a high PIM2 score （ OR = 1. 028,95 % CI：1.012 - 1. 043, P 〈 0.001 ） and multiple organ dysfunction syndrome（ OR = 4. 160,95% CI： 1. 728 - 10. 012, P = 0. 001 ） were independent risk factors for mortality in children with severe sepsis. The fluid overload was significantly associated with mortality （ OR = 1. 309, 95% CI： 1. 158 -1. 480,P 〈0.001 ）,even after adjustment for age and illness severity assessed by PIM2 scores. Fluid overload achieved AUC of 0.741 （95 % CI：0. 661 - 0. 820, P 〈 0.001 ） for predicting mortality in children with severe sepsis. Conclusion Fluid overload developed during the first 72 hours after admission is independently associated with and predictive of PICU mortality in children with severe sepsis.

关 键 词：严重脓毒症 病死率 容量超负荷 儿童死亡指数Ⅱ(评分) 预测价值 

分 类 号：R720.597[医药卫生—急诊医学]