2018至2021年山东省多中心PICU严重脓毒症儿童的流行病学特征分析  

Epidemiological characteristics of children with severe sepsis in multi-center PICU in Shandong province from 2018 to 2021

作　　者：陈捷 靳有鹏 董胜英[4] 山东省儿童脓毒症诊治协作组[5] Chen Jie;Jin Youpeng;Dong Shengying;Diagnosis and Treatment Collaboration Group for Sepsis in Children in Shandong Province(Shandong University,Jinan 250021,China;Pediatric Intensive Care Unit,Shandong Provincial Hospital Afiliated to Shandong First Medical University,Jinan 250021,China;Shandong Provincial Hospital,Jinan 250021,China;Pediatric Intensive Care Unit,Liaocheng People's Hospital,Liaocheng 252000,China;不详)

机构地区：[1]山东大学,济南250021 [2]山东第一医科大学附属省立医院小儿重症医学科,济南250021 [3]山东省立医院,济南250021 [4]聊城市人民医院小儿重症医学科,252000 [5]不详

出　　处：《中国小儿急救医学》2023年第4期266-270,共5页Chinese Pediatric Emergency Medicine

基　　金：山东省重点研发计划(2015GSF118123)。

摘　　要：目的调查2018至2021年山东省多中心PICU儿童严重脓毒症的流行病学特点、治疗情况以及预后的变化,为儿童严重脓毒症的防治提供科学依据。方法山东省19家医院的PICU参与了这项多中心观察性研究,对2018年1月1日至2021年12月31日收治的年龄>28 d且≤18岁的严重脓毒症患儿进行筛选和评估,对患儿的流行病学特征、临床特点、治疗情况及预后数据进行整理和分析。结果(1)2018至2021年,PICU收治的住院患儿总数及严重脓毒症患儿数量整体呈下降趋势,2020年下降最显著;(2)这4年间,PICU住院患儿中,严重脓毒症的患病率波动于1.95%~2.37%,年龄中位数波动于1.29~2.00岁,男性多于女性;(3)入院24 h儿童序贯器官衰竭评分中位数波动于5~6分;(4)最常见的原发感染部位均为呼吸系统,其次为消化系统;(5)自2020年,接受液体复苏、机械通气、血液净化及糖皮质激素治疗的比例显著下降;(6)住PICU中位时长为9.22~11.51 d;(7)住PICU中位费用由2018年的41075元显著下降至2021年的30972元;(8)院内病死率整体呈下降趋势,2019年最高达17.61%,2020年最低为12.77%。结论2018至2021年,山东省PICU儿童严重脓毒症的患病率无显著变化,院内病死率整体呈下降趋势,且住PICU费用显著减少。Objective To investigate the epidemiological characteristics,treatment and prognosis of pediatric severe sepsis in PICU in Shandong Province from 2018 to 2021,in order to provide a scientific basis for the prevention and treatment of severe sepsis in children.Methods A multicenter retrospective observational study was conducted at PICUs from 19 hospitals in Shandong Province.Patients aged>28 days and≤18 years,diagnosed with severe sepsis or septic shock who admitted to these PICUs during January 1,2018 and December 31,2021 were enrolled.Results(1)From 2018 to 2021,the total number of hospitalized children and the number of children with severe sepsis admitted to the PICU showed an overall downward trend,with the most significant decrease in 2020.(2)During the study period,among the hospitalized children in PICU,the prevalence rate of children with severe sepsis fluctuated from 1.95%to 2.37%,and the median age fluctuated from 1.29 to 2.00 years old,more males than females.(3)Median pediatric sequential organ failure assessment score fluctuated between 5 and 6 at 24 hours after admission.(4)The most common primary infection site was the respiratory system,followed by the digestive system.(5)Since 2020,the propotion of children receiving fluid resuscitation,blood purification,mechanical ventilation,and glucocorticoid therapy has decreased significantly.(6)The median length of PICU stay was 9.22 to 11.51 days.(7)The median PICU costs decreased significantly from 41075 yuan in 2018 to 30972 yuan in 2021.(8)In-hospital mortality showed an overall decreased trend,reaching a maximum of 17.61%in 2019 and a minimum of 12.77%in 2020.Conclusion From 2018 to 2021,there was no significant change in the incidence of pediatric severe sepsis in PICUs in Shandong province while the overall in-hospital mortality rate and the PICU costs showed a reduced trend.

关 键 词：严重脓毒症 儿童 病死率 患病率 山东省 

分 类 号：R720.597[医药卫生—急诊医学]