儿童中毒休克综合征的临床特点及管理  

Clinical characteristics and management of toxic shock syndrome in children

作　　者：黄娇甜[1] 卢秀兰[2] 肖政辉[2] 张新萍[1] 颜海鹏[1] 胡霞 周武 Huang Jiaotian;Lu Xiulan;Xiao Zhenghui;Zhang Xinping;Yan Haipeng;Hu xia;Zhou wu(Department of Pediatric Intensive Care Unit,Children’s Hospital of Hunan Province,Changsha,China;Children’s Hospital of Hunan Province,,Changsha,China)

机构地区：[1]湖南省儿童医院重症医学科 [2]湖南省儿童医院

出　　处：《实用休克杂志（中英文）》2022年第1期14-19,34,共7页Journal of Practical Shock

基　　金：湖南省科技厅湖南省重点实验室、工程技术研究中心和科技基础条件平台组项目(项目编号:2018TP1028);湖南省科技创新计划项目(项目编号:2018SK50404);湖南省儿童医院1233卫生人才培养计划项目(项目编号:湘儿医行[2018]22号);湖南省临床重点专科建设项目(项目编号:07975)。

摘　　要：目的 了解儿童中毒休克综合征的临床特点、治疗和预后。方法 对2019年1月至2021年12月期间在湖南省儿童医院重症医学科住院,确诊或疑诊为中毒休克综合征(TSS)的儿童的临床数据、生物学结果和治疗结果进行了回顾性研究。结果 38名研究对象中,18例为链球菌中毒休克综合征(STSS),20例为非链球菌中毒休克综合征(NSTSS)。与NSTSS相比,STSS出现神经系统改变、咽部充血、肺部浸润及毛细血管渗漏的情况更常见,表现出更高的器官功能障碍评分(20.9±5.4 vs 10.7±3.8分,P=0.01),更频繁地需要呼吸支持(77.8 vs 40.0%,P=0.02),并有较长的PICU住院时间(10.5±6.3 vs 5.3±3.6d,P=0.04)。但NSTSS组患儿出现皮疹的情况多于STSS组。患儿缺乏克林霉素及IVIG的治疗与较高的病死率可能相关。结论 尽管涉及功能相似的毒素,STSS和NSTSS因其临床体征、感染来源和预后有所不同。而如何早期识别、早期干预是改善预后的关键。Objective To investigate the clinical characteristics,treatment and prognosis of toxic shock syndrome in children.Methods We conducted a retrospective study of clinical data,biological outcomes,and treatment outcomes of children admitted to the Intensive Care Department of Children’s Hospital of Hunan Province from January 2019 to December 2021 with confirmed or suspected toxic shock complex(TSS).Results 38 children were included in the study,18 were streptococcal toxic shock syndrome(STSS) and 20 were non-streptococcal toxic shock syndrome(NSTSS).Compared with NSTSS group,STSS group showed more frequent neurological symptom,pharyngeal congestion,pulmonary infiltration,and capillary leakage,showed a higher organ dysfunction score(20.9±5.4 vs 10.7±3.8,P=0.01),and required respiratory support more frequently(77.8 vs 40.0%,P=0.02).There was also a longer hospital stay in PICU(10.5±6.3 vs 5.3±3.6 days,P=0.04).However,rashes were more common in the NSTSS group than in the STSS group.Treatment with clindamycin and IVIG deficiency may be associated with higher mortality.Conclusions Despite the involvement of functionally similar toxins,STSS and NSTSS differ due to their clinical signs,source of infection,and prognosis.Early antitoxin treatment is very important,and how to identify and intervene early is the key to improve the prognosis.

关 键 词：儿童 中毒休克综合征 临床特征 治疗 预后 

分 类 号：R725.9[医药卫生—儿科]