儿童脓毒性休克伴心肌病病例对照研究  

Case-control study in pediatric septic shock with cardiomyopathy

作　　者：朱莉娟 李少军[2] 谭利平[2] Zhu Lijuan;Li Shaojun;Tan Liping(Pediatrics of East Hospital of Sichuan Provincial People′s Hospital,Chengdu 610100,China;Emergency Department of Children′s Hospital Affiliated to Chongqing Medical University,Key Laboratory of Ministry of Education,National Clinical Research Center for Child Health and Disease(Chongqing),National International Science and Technology Cooperation Base for Major Child Development Diseases,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]四川省人民医院东院儿科,成都610100 [2]重庆医科大学附属儿童医院急诊科,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心(重庆),儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,400014

出　　处：《中国小儿急救医学》2022年第9期681-685,共5页Chinese Pediatric Emergency Medicine

基　　金：重庆市科学技术局自然科学基金面上项目(cstc2020jcyj-msxmX0642);重庆市卫生健康委项目(2022WSJK053)。

摘　　要：目的回顾性分析儿童脓毒性休克发生心肌病的危险因素及生存情况。方法收集2015年1月至2021年3月入住重庆医科大学附属儿童医院PICU的脓毒性休克患儿, 病例组为脓毒性休克伴心肌病患儿, 使用倾向性评分匹配法从脓毒性休克不伴心肌病患儿中以1∶2的比例匹配对照组。采集两组的基本临床资料、心肌标志物、心脏超声指标、器官功能指标及临床结局指标。结果病例组纳入46例, 对照组92例, 二组在年龄、性别、小儿危重病例评分、基础疾病方面差异无统计学意义。病例组的左室射血分数[51.0%(43.0%, 62.0%)比65.5%(60.6%, 69.0%)]、左心室短轴缩短率(FS)[26%(21%, 33%)比35%(32%, 38%)]、氧合指数(PaO2/FiO2)[324.0(234.3, 400.0)mmHg比400.0(265.8, 445.0)mmHg]低于对照组, 心电图指标ST段改变发生率(21.7%比3.3%)、乳酸[3.20(1.20, 5.87)mmol/L比1.80(1.20, 3.40)mmol/L]、血管活性药物评分[25.14(14.84, 42.70)分比15.04(10.00, 26.70)分]高于对照组, 差异均有统计学意义(均P<0.05)。两组PICU病死率(15.2%比14.1%)和28 d病死率(39.1%比29.3%)差异无统计学意义(P>0.05)。Logistic回归分析显示, FS与脓毒性休克发生心肌病相关[OR(95%CI):0.795 (0.714~0.870), P<0.001]。肌钙蛋白I升高的脓毒性休克患儿死亡风险增高。结论 FS是脓毒性休克发生心肌病的独立危险因素。脓毒性休克伴心肌病与不伴心肌病的患儿存活率无差别, 肌钙蛋白I与儿童脓毒性休克的预后相关。Objective The risk factors and survival conditions of cardiomyopathy in childhood septic shock were retrospectively analyzed.Methods Children with septic shock admitted to the PICU at Children′s Hospital of Chongqing Medical University from January 2015 to March 2021 were collected.The case group included children with septic shock and cardiomyopathy.The propensity score matching method was used to match children with septic shock without cardiomyopathy in a 1∶2 ratio as the control group.Basic clinical data,myocardial biomarkers,cardiac ultrasound indicators,organ function indicators and clinical outcome indicators were collected from two groups.Results Forty-six patients were included in the case group and 92 patients in the control group.There were no significant differences in age,sex,pediatric critical care score,and basic disease between two groups.Moreover,left ventricular ejection fraction[51.0%(43.0%,62.0%)vs.65.5%(60.6%,69.0%)],left ventricle short-axis shortening rate(FS)[26%(21%,33%)vs.35%(32%,38%)],and oxygenation index(PaO2/FiO2)[324.0(234.3,400.0)mmHg vs.400.0(265.8,445.0)mmHg]in case group were lower than those in control group,while the incidence of the ST segment changes of the ECG index(21.7%vs.3.3%),lactate[3.20(1.20,5.87)mmol/L vs.1.80(1.20,3.40)mmol/L],and vasoactive drug score[25.14(14.84,42.70)points vs.15.04(10.00,26.70)points]in case group were higher than those in control group,the differences were all statistically significant(all P<0.05).The differences of PICU mortality(15.2%vs.14.1%)and 28 d mortality(29.1%vs.29.3%)between two groups were not significant(P>0.05).The Logistic regression analysis showed that the FS was associated with cardiomyopathy occurring in septic shock[OR(95%CI):0.795(0.714~0.870),P<0.001].Children with septic shock with elevated cardiac troponin I had an increased risk of death.Conclusion FS is an independent risk factor for cardiomyopathy in septic shock.There is no difference in survival between septic shock with and without cardiomyopathy.Cardiac troponi

关 键 词：脓毒性休克 脓毒性心肌病 儿童 病死率 危险因素 

分 类 号：R720.597[医药卫生—急诊医学] R725.4[医药卫生—儿科]