青海地区儿童脓毒症致急性心肌损害的危险因素及预防对策  

Investigation on risk factors of acute myocardial damage caused by childhood sepsis in Qinghai area and preventive measures

作　　者：王文海 马如海 万有仓 WANG Wen-hai;MA Ru-hai;WAN You-cang(Department of Pediatric Critical Medicine,Qinghai Women′s and Children′s Hospital,Xining,Qinghai 810000,China)

机构地区：[1]青海省妇女儿童医院儿童重症医学科,青海西宁810000

出　　处：《公共卫生与预防医学》2022年第2期113-117,共5页Journal of Public Health and Preventive Medicine

摘　　要：目的初步分析青海地区儿童脓毒症致急性心肌损害的情况及重要危险因素,并在前述基础上分析讨论预防对策。方法研究选取青海省妇女儿童医院2016年1月至2020年12月间就诊的脓毒症患儿385例纳入分析,其中包含因脓毒症引发急性心肌损害的患儿158例(病例组),其余227例(对照组)未见心肌损害。研究收集全部患儿的社会人口学信息等基本情况,同时收集血清肌钙蛋白I(cTnI)、CK-MB水平信息(使用化学发光法测定);以及血清CRP水平、PCT水平。对比分析患儿心肌损害患儿相关指标水平,以及与对照组患儿的差别情况。随后分析与并见急性心肌损害发生存在潜在关联的危险因素。使用SPSS统计软件包分析数据。cTnI酶标免疫法测定,试剂由南京基蛋生物技术有限公司提供;医学为(0.00~0.01)μg/mL,cTnI水平正常组(≤0.01μg/mL)和cTnI水平升高组(>0.01μg/mL);CK-MB>5 ng/mL为心肌肌损伤阳性标准;CRP医学参考值<8mg/L,PCT<0.1ng/mL;检测CRP使用比浊法,所用仪器为BNⅡ特异性蛋白分析仪,相关试剂购自德国Deling公司。小儿危重病例评分(PCIS)和小儿死亡危险因素评分(PRISMⅢ)(评估2次,取最低值)。结果研究中男性患儿居多,并积极心肌损害的患儿低热表现者所占比例较高,同时病情与对照组比较更重,可见PCIS评分更低,PRISMⅢ更高,差异均具有统计学意义(P<0.05)。病例组血清肌钙蛋白I(cTnI)、CK-MB、CRP、PCT水平显著高于对照组,差异均具有统计学意义(P<0.05);血清白蛋白水平显著低于对照组,差异具有统计学意义(P<0.05);以是否出现心肌损害为因变量,以潜在影响因素为自变量(社会人口学因素、住院治疗基本情况、心肌损伤相关指标水平等)进行危险因素分析。包含单因素分析(潜在混杂因素调整)以及多因素分析。结果显示,年龄增高、低热、PCT增高、低白蛋白水平(≤25g/L)、PRISMⅢ增高为心肌损害发生的危险Objective To preliminarily analyze the acute myocardial damage and important risk factors caused by sepsis in children in Qinghai,and analyze and discuss preventive measures on the basis of the foregoing.Methods The study selected 385 children with sepsis in our hospital from January 2016 to December 2020 and included 158 children with acute myocardial damage caused by sepsis(case group),and the remaining 227 cases(control group)were not seen Myocardial damage.The study collects basic information such as sociodemographic information of all children,and collects serum troponin I(cTnI)and CK-MB levels(determined by chemiluminescence method);as well as serum CRP levels and PCT levels.To compare and analyze the levels of related indexes in children with myocardial damage,and the differences from those in the control group.Then analyze and see the risk factors that are potentially associated with acute myocardial damage.Use SPSS statistical software package to analyze the data.cTnI enzyme-labeled immunoassay assay,reagents are provided by Nanjing Jidan Biotechnology Co.,Ltd.;medicine is(0.00-0.01)μg/mL,cTnI level normal group(≤0.01μg/mL)and cTnI level elevated group(>0.01μg/mL));CK-MB>5 ng/mL is the positive standard for myocardial muscle injury;CRP medical reference value<8mg/L,PCT<0.1 ng/mL;CRP is detected by the turbidimetric method,and the instruments and reagents are manufactured by German Deling BNⅡspecific protein analyzer and original matching reagents.Pediatric Critical Case Score(PCIS)and Pediatric Death Risk Factor Score(PRISMⅢ)(evaluate twice,take the lowest value).Results In this study,the majority of male children were male,and the proportion of children with active myocardial damage had a higher proportion of low-grade fever.At the same time,the disease was more severe than the control group.It can be seen that the PCIS score is lower and the PRISMⅢis higher.The difference is statistically significant.(P<0.05).The serum troponin I(cTnI),CK-MB,CRP,and PCT levels in the case group were signific

关 键 词：儿童 脓毒症 急性心肌损害 危险因素 预防对策 

分 类 号：R181[医药卫生—流行病学]