重症监护病房脓毒症患儿预后及其影响因素分析  

The prognosis of children with sepsis in PICU and its related factors

作　　者：黎萍[1] 杨志勇[1] 韦丹[1] 

机构地区：[1]广西医科大学第一附属医院,南宁530021

出　　处：《广西医科大学学报》2017年第6期857-860,共4页Journal of Guangxi Medical University

摘　　要：目的:探讨重症监护病房脓毒症患儿的预后情况及其影响因素。方法:选取2015年2月1日至2016年8月1日在广西医科大学第一附属医院儿童重症监护病房(PICU)住院的116例脓毒症患儿作为研究对象。收集患者的临床资料,记录28d病死率。采用多因素Cox比例风险回归分析影响患儿预后的危险因素。结果:进入PICU 28d后共有28例(24.1%)患儿死亡。多因素Cox回归模型分析结果显示:25羟基维生素D[25(OH)D]水平较高是影响预后的保护因素(P<0.05),第三代小儿死亡危险评分(PRISMⅢ)水平较高是影响预后的独立危险因素(P<0.05)。25(OH)D充足组29例中死亡3例(10.3%)、不足组35例中死亡7例(20.0%)、缺乏组52例中死亡18例(34.6%),3组病死率比较差异有统计学意义(P<0.05);3组平均生存时间分别为25.386d(95%CI:22.571~28.201)、23.799d(95%CI:20.954~26.644)、20.601d(95%CI:17.729~23.474)。结论:PICU脓毒症患儿的预后情况较差,25(OH)D水平与PICU脓毒症患儿的预后密切相关,提高患儿25(OH)D水平对患儿预后可能具有积极的作用。Objective： To investigate the prognosis in children with sepsis in pediatric intensive care unit （PICU） and its influencing factor. Methods： The clinical data from 116 children with sepsis admitted to PICU of our hospital from February 1st 2015 to August 1st 2016 were retrospectively analyzed. 28-day mortality were recorded. The risk factors influencing prognosis were analyzed by Cox proportional hazards regression. Results： 28-day mortality was 24.1% （28/116）. High 25-hydroxyvitamin D [-25（OH）D] level was a protection factor, while high pediatric risk of mortality Ⅲ （PRISM Ⅲ ） score was an independent risk factor for prognosis in children with sepsis in PICU （P〈0.05）. 28-day mortality was 10.3%（3/29） in 25（OH）D sufficiency group, 20.0% （7/35） in insufficiency group and 34.6% （18/52） in deficiency group. There was significant difference in 28-day mortality among the three groups （P〈0.05）. The average survival time in sufficiency, insufficiency and deficiency groups were 25. 386 d （95% CI： 22. 571-28. 201）, 23. 799 d （95%0 CI： 20. 954-26. 644）, 20. 601 d （95% CI： 17. 729-23. 474）. Conclusion： The sepsis children in PICU has a poor prognosis. 25（OH）D level was closely related to their prognosis, and its high level might improve the clinical outcomes.

关 键 词：脓毒症患儿 25(OH)D 预后 影响因素 

分 类 号：R720.59[医药卫生—儿科]