外周血白细胞不高的脓毒症患儿84例临床分析  

Clinical analysis in 84 children with the sepsis of non-elevated peripheral blood leukocytes

作　　者：侯伟[1] 张丽君[1] 张曼[1] 王亚坤[1] 贾美轩 田利远[1] Hou Wei;Zhang Lijun;Zhang Man;Wang Yakun;Jia Meixuan;Tian Liyuan(First Department of Respiratory Medicine, Hebei Children's Hospital affiliated to Hebei Medical University, Shijiazhuang 050031, China)

机构地区：[1]河北医科大学附属河北省儿童医院呼吸一科,河北石家庄050031

出　　处：《临床荟萃》2021年第9期799-802,共4页Clinical Focus

摘　　要：目的了解外周血白细胞不高的脓毒症患儿临床特征及病原组成。方法选取2013-2020年河北省儿童医院住院治疗的84例外周血白细胞不高的脓毒症患儿临床资料进行回顾性分析;将仅检出革兰阳性菌患儿分为革兰阳性菌感染组(n=27),仅检出革兰阴性菌患儿分为革兰阴性菌感染组(n=26),并比较两组临床资料。结果84例患儿,发病年龄以0~<1岁为主(47例,55.9%);伴有发热81例(96.4%),出现精神状态改变80例(95.2%);外周血C-反应蛋白中位数为157.7 g/L,降钙素原中位数为12.66μg/L;首发感染部位呼吸系统最常见(43例,51.2%);病原微生物仅检出细菌55例(65.5%),仅检出病毒6例(7.1%),仅检出肺炎支原体2例(2.4%),多种病原共检出21例(25.0%),检出细菌中以多重耐药菌为主;诊断严重脓毒症及脓毒性休克37例(44.0%);治愈58例(69.0%)。革兰阳性菌感染组与革兰阴性菌感染组相比,首发感染部位、外周血白细胞计数、中性粒细胞计数、中性粒细胞百分数方面差异有统计学意义(P<0.05)。结论外周血白细胞不高的脓毒症仍以多重耐药细菌感染为主,发病年龄较小,病死率较高,可根据首发感染部位、外周血白细胞及中性粒细胞计数初步判断细菌分类,早期开展经验性治疗。Objective To understand the clinical characteristics and pathogenic composition of non-elevated peripheral blood leukocytes in children with sepsis.Methods A retrospective analysis was performed in 84 children with sepsis who had non-elevated peripheral blood leukocytes hospitalized in Hebei Children's Hospital from 2013 to 2020.Children with only gram-positive bacteria were divided into gram-positive bacteria infection group(n=27)and children only with gram-negative bacteria were divided into gram-negative bacteria infection group(n=26).Furthermore,the clinical data in groups were compared.Results In 84 children,the age of onset was mainly from 0 to<1 year(47 cases,55.9%).There were 81 cases(96.4%)with fever and 80 cases(95.2%)with abnormal mental state.The median of peripheral blood C-reactive protein and procalcitonin were 157.7 g/L and 12.66μg/L,respectively.Respiratory system was the most common site of first infection(43 cases,51.2%).Fifty-five cases(65.5%)were only detected with bacteria and 6 cases(7.1%)were only detected with viruses.Two cases(2.4%)were only detected with Mycoplasma pneumoniae,and a total of 21 cases(25.0%)were detected with multiple pathogens.Among them,the majority of the detected bacteria were multi-drug resistant bacteria.Thirty-seven cases(44.0%)were diagnosed with severe sepsis and septic shock;58 cases were cured(69.0%).Compared with the gram-negative bacteria infection group,the gram-positive bacteria infection group had statistical differences in the terms of first infection,peripheral blood white blood cell count,neutrophil count,and neutrophil percentage(P<0.05).Conclusion Multi-drug resistant bacteria are the main infections for non-elevated peripheral blood leukocytes of sepsis.The age of onset was relatively small and the mortality rate was relatively high.First-onset infection site,peripheral blood leukocytes and neutrophil counts are used to preliminarily determine bacteria identification,and carry out early empirical treatment.

关 键 词：脓毒症 儿童 病原组成 

分 类 号：R631[医药卫生—外科学]