基础疾病对脓毒性休克患儿临床特征和预后的影响  

Effects of basic diseases on clinical characteristics and prognosis of septic shock in children

作　　者：高恒妙[1,2] 樊超男 陈雪婷[1,2] 苏国云 钱素云 Gao Hengmiao;Fan Chaonan;Chen Xueting;Su Guoyun;Qian Suyun(Department of Pediatric Intensive Care Unit,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;National Clinical Research Center of Respiratory Diseases,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院重症医学科,100045 [2]国家呼吸系统疾病临床医学研究中心,北京100045

出　　处：《中国小儿急救医学》2021年第2期107-110,共4页Chinese Pediatric Emergency Medicine

基　　金：北航-首医大数据精准医疗高精尖创新中心计划(BHME-201902)。

摘　　要：目的了解儿童重症监护病房(pediatric intensive care unit,PICU)内不同基础性疾病并发脓毒性休克(septic shock,SS)患儿的临床特征和预后。方法回顾性收集2017年1月1日至2019年12月31日北京儿童医院PICU收治的SS患儿病历资料,按照有无基础疾病、基础疾病种类进行分组,总结不同基础疾病条件下SS的临床特征、预后及病原分布情况。结果研究期间共收治218例SS患儿,总病死率为21.6%(47/218);合并基础疾病者141例[64.7%(141/218)],病死率24.1%(34/141);处于化疗骨髓抑制期的恶性血液病和肿瘤患儿病死率最高(17/45,37.5%),无基础性疾病者病死率最低(13/77,16.9%)。合并基础性疾病的SS患儿以革兰阴性菌感染为主(63.1%,41/65),恶性血液病及肿瘤化疗后骨髓抑制期患儿革兰阴性菌感染最高(80.0%,20/25)。革兰阳性菌感染在无基础疾病组最高(52.1%,25/48)。多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)在恶性血液病及肿瘤化疗后骨髓抑制期者的发生率最高(95.6%,43/45),无基础疾病组最低(59.7%,46/77)。结论伴发基础疾病,尤其是血液肿瘤的患儿化疗后发生SS时病原体以革兰阴性菌最常见,病死率和MODS发生率高;无基础疾病者以革兰阳性菌最常见,病死率和MODS发生率相对较低。Objective To investigate the clinical features and prognosis of septic shock(SS)children with different basic diseases in pediatric intensive care unit(PICU).Methods The medical records of SS children admitted to PICU at Beijing Children′s Hospital from January 1,2017 to December 31,2019 were collected retrospectively.They were grouped according to the presence or absence of basic diseases and types of basic diseases.The clinical characteristics,prognosis and pathogens of SS under different basic diseases were summarized.Results A total of 218 children with SS were included during the study period,and the overall case fatality rate was 21.6%(47/218).There were 141 cases with basic diseases,accounting for 64.7%(141/218)and 24.1%(34/141)case fatality rate.The mortality rate was highest(37.5%,17/45)in the malignant hematologic diseases and tumors patients with post-chemotherapy bone marrow suppression,and lowest(16.9%,13/77)in patients with no underlying diseases.Gram-negative bacterial infection was more common in SS children with underlying diseases(63.1%,41/65),and was highest in the malignant hematologic diseases and tumors patients with post-chemotherapy bone marrow suppression(80.0%,20/25).Gram-positive bacteria accounted for the highest proportion in the group without underlying disease(52.1%,25/48).The incidence of multiple organ dysfunction syndrome(MODS)was the highest(95.6%,43/45)in the malignant hematologic diseases and tumors patients with post-chemotherapy bone marrow suppression,and the lowest(59.7%,46/77)in the group without underlying disease.Conclusion Gram-negative bacteria is the most common pathogen in SS children with underlying diseases,especially in malignant hematologic diseases and tumors patients with post-chemotherapy bone marrow suppression,and with high mortality and incidence of MODS.Gram-positive bacteria is the most common pathogen for those without underlying diseases,with a relatively low mortality and incidence of MODS.

关 键 词：脓毒性休克 基础性疾病 预后 儿童重症监护病房 

分 类 号：R720.597[医药卫生—急诊医学]