恶性血液肿瘤患儿合并脓毒性休克死亡危险因素分析  

Risk factors for mortality of septic shock in pediatric patients with hematological malignancies

作　　者：刘婷华 汤昔康[1] 陈泽楷[1] 雷嘉颖 许吕宏[1] 李天文[1] 麦友刚[1] 

机构地区：[1]中山大学孙逸仙纪念医院PICU,广东广州510120

出　　处：《中国实用儿科杂志》2017年第5期353-356,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨儿童重症监护病房(PICU)恶性血液肿瘤合并脓毒性休克患儿的临床特点及其死亡危险因素。方法对中山大学孙逸仙纪念医院PICU 2012年3月至2015年9月收治的43例恶性血液肿瘤合并脓毒性休克患儿的临床资料进行回顾性分析。结果43例休克患儿中,存活27例,死亡16例,病死率37.2%。最常见感染部位为肺部(74.4%),其次为胃肠道(39.5%)。病原学检查阳性者26例,共分离出病原菌43株,其中G+菌5株(11.6%),G-菌31株(72.1%),真菌7株(16.3%),以大肠埃希菌占首位(6/43,14.0%)。存活组与死亡组比较,患儿在年龄、化疗阶段、感染至休克累计时间、粒细胞缺乏至休克累计时间、多器官功能障碍(MODS)受累器官数、肺部受累、低钙血症、液体复苏后6 h的氧合指数及乳酸水平、多巴胺使用剂量以及是否需要机械通气方面,差异均具有统计学意义(P均<0.05)。多因素Logistic回归分析结果显示:与脓毒性休克患儿死亡相关的变量为液体复苏后6 h的乳酸水平及机械通气的应用。结论恶性血液肿瘤合并脓毒性休克经液体复苏后6 h仍存在高乳酸中毒、合并低钙血症以及需要机械通气的患儿病死率高,应更为重视。Objective To study clinical characteristics and risk factors for mortality of septic shock patients with hema- tological malignancies in pediatric intensive care unit （PICU）. Methods A retrospective analysis of records of pediatric patients with hematological malignancy and septic shock was performed. In our study, 43 cases admitted to PICU in Sun Yat- sen Memorial Hospital between March 2012 and September 2015 were included. Results Among the 43 cases, 16 died,while the other 27 survived. The percentage of mortality was 37.2%. Pulmonay infection （74.4%） and gastrointestinal tract infection （ 39.5% ） were the common causes of septic shock in these patients. Etiological examination revealed 43 kinds of pathogenic bacteria in 26 cases. The percentage of gram-positive bacteria, gram-negative bacteria and fungus was 11.6%, 72.1% and 16.3%, respectively. Escherichia coli was found to be the main pathogen （6/43,14.0%）. Between tlle survival group and the mortality group, there were significant differences in the parameters of age, chemotherapy courses, time from infection to shock, time from neutropenia to shock, multiple organs dysfunction, pulmonary infection, hypocalcemia, oxygenation index and serum lactic acid concentration after 6 hours of fluid resuscitation, requirement of dopamine and mechanical ventilation （P 〈 0.05 ）. By logistic regression analysis, mortality was associated with the variables of serum lactic acid concentration after 6 hours of fluid resuscitation and requirement of mechanical ventilation. Conclusion The risk factors for mortality of septic shock in pediatric patients with hematological malignancies are hyperlactacidemia after 6 hours of fluid resuscitation, hypocalcemia and requirement of mechanical ventilation.

关 键 词：儿童 血液肿瘤 脓毒性休克 危险因素 

分 类 号：R72[医药卫生—儿科]