脓毒性休克患儿呼吸道病毒感染情况及其对临床结局的影响  

Respiratory virus infection and its influence on outcome in children with septic shock

作　　者：刘刚[1] 张晨美[2] 李莺[3] 孙俊怡 成怡冰 陈宇萍 王志华[6] 任宏[7] 刘春峰[8] 靳有鹏 陈森[10] 王晓敏[11] 许峰[4] 徐香芝[2] 朱秋皎[3] 王向蝶 刘鑫惠 刘月 胡杨[8] 王伟 艾奇[11] 党红星[4] 高恒妙[1] 樊超男[1] 钱素云[1] Liu Gang;Zhang Chenmei;Li Ying;Sun Junyi;Cheng Yibing;Chen Yuping;Wang Zhihua;Ren Hong;Liu Chunfeng;Jin Youpeng;Chen Sen;Wang Xiaomin;Xu Feng;Xu Xiangzhi;Zhu Qiujiao;Wang Xiangdie;Liu Xinhui;Liu Yue;Hu Yang;Wang Wei;Ai Qi;Dang Hongxing;Gao Hengmiao;Fan Chaonan;Qian Suyun(Department of Pediatric Intensive Care Unit,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Pediatric Intensive Care Unit,Children′s Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Pediatric Intensive Care Unit,Children′s Hospital Affiliated to Soochow University,Suzhou 215025,China;Department of Pediatric Critical Care,Children′s Hospital of Chongqing Medical University,Chongqing 400014,China;Department of Pediatric Intensive Care Unit,Henan Children′s Hospital,Zhengzhou 450018,China;Department of Pediatric Intensive Care Unit,Baoding Children′s Hospital,Baoding 071051,China;Department of Pediatric Intensive Care Unit,Shanghai Children′s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Pediatric Intensive Care Unit,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Pediatric Intensive Care Unit,Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Department of Pediatric Intensive Care Unit,Tianjin Children′s Hospital,Tianjin 300074,China;Department of Hematology,Tianjin Children′s Hospital,Tianjin 300074,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院重症医学科,北京100045 [2]浙江大学医学院附属儿童医院重症医学科,杭州310003 [3]苏州大学附属儿童医院重症医学科,苏州215025 [4]重庆医科大学附属儿童医院重症医学科,重庆400014 [5]河南省儿童医院重症医学科,郑州450018 [6]保定市儿童医院重症医学科,保定071051 [7]上海交通大学医学院附属上海儿童医学中心重症医学科,上海200127 [8]中国医科大学附属盛京医院儿童重症监护病房,沈阳110004 [9]山东第一医科大学附属省立医院儿童重症医学科,济南250021 [10]天津市儿童医院重症医学科,天津300074 [11]天津市儿童医院血液科,天津300074

出　　处：《中华儿科杂志》2024年第3期211-217,共7页Chinese Journal of Pediatrics

基　　金：北京市科学技术委员会首都临床诊疗技术研究及转化应用项目(Z211100002921063)。

摘　　要：目的了解儿童重症监护病房(PICU)内脓毒性休克患儿常见呼吸道病毒的感染情况及其对临床结局及预后的影响。方法收集2018年1月至2021年12月中国10家医院PICU中脓毒性休克患儿的临床和诊疗相关数据进行回顾性分析。按休克发生在新型冠状病毒感染疫情前后分为疫情前和疫情后两组,对比分析两组患儿临床特征以及呼吸道病毒构成变化;以年龄、恶性肿瘤基础病、细菌、真菌、其他病毒为匹配因素,利用1∶1倾向性评分匹配方法分为呼吸道病毒组和无呼吸道病毒组,比较两组患儿临床特征及诊治差异。组间比较采用两独立样本t检验、Mann-Whitney U检验和χ^(2)检验,利用Logistic回归分析呼吸道病毒感染和部分临床结局的相关性。结果共纳入脓毒性休克患儿1247例,年龄37(11,105)月龄,其中男748例。疫情前组530例,疫情后组717例,呼吸道病毒阳性率分别为14.9%(79例)和9.8%(70例)。疫情前、后两组脓毒性休克季节分布比例秋、冬季分别为28.9%(153/530)、30.3%(161/530)和25.9%(185/717)、28.3%(203/717),对应的呼吸道病毒阳性率分别为19.6%(30/153)、21.1%(34/161)和15.7%(29/185)、15.3%(31/203)。疫情后组流感病毒和腺病毒阳性率均低于疫情前组[2.1%(15/717)比7.5%(40/530)、0.7%(5/717)比3.2%(17/530),χ^(2)=21.51、11.08,均P<0.05],但鼻病毒高于疫情前组[1.7%(12/717)比0.2%(1/530),χ^(2)=6.51,P=0.011]。倾向性评分匹配后呼吸道病毒组和无呼吸道病毒组各147例。前者呼吸衰竭和急性呼吸窘迫、弥散性血管内凝血功能障碍和免疫球蛋白使用占比均高于后者[77.6%(114/147)比59.2%(87/147)、17.7%(26/147)比4.1%(6/147)、15.6%(25/147)比4.1%(7/147)、35.4%(52/147)比21.4%(32/147),χ^(2)=11.07、14.02、11.06、6.67,均P<0.05],前者PICU住院时间长于后者[7(3,16)比3(1,7)d,Z=5.01,P<0.001]。单因素Logistic回归分析提示存在呼吸道病毒感染与发生呼吸衰竭和弥散性凝血功能障碍、�Objective To investigate respiratory virus infection in children with septic shock in pediatric care units(PICU)in China and its influence on clinical outcomes.Methods The clinical data of children with septic shock in children′s PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected.They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease,and the characteristics and composition of respiratory virus in the 2 groups were compared.Matching age,malignant underlying diseases,bacteria,fungi and other viruses,a new database was generated using 1∶1 propensity score matching method.The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection;their clinical characteristics,diagnosis,and treatment were compared by t-test,rank sum test and Chi-square test.The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression.Results A total of 1247 children with septic shock were included in the study,of them 748 were male;the age was 37(11,105)months.In the pre-and post-COVID-19 groups,there were 530 and 717 cases of septic shock,respectively;the positive rate of respiratory virus was 14.9%(79 cases)and 9.8%(70 cases);the seasonal distribution of septic shock was 28.9%(153/530)and 25.9%(185/717)in autumn,and 30.3%(161/530)and 28.3%(203/717)in winter,respectively,and the corresponding positive rates of respiratory viruses were 19.6%(30/153)and 15.7%(29/185)in autumn,and 21.1%(34/161)and 15.3%(31/203)in winter,respectively.The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group(2.1%(15/717)vs.7.5%(40/530),and 0.7%(5/717)vs.3.2%(17/530),χ^(2)=21.51 and 11.08,respectively;all P<0.05).Rhinovirus virus were higher than those in the pre-Covid-19 group(1.7%(12/717)vs.0.2%(1/530),χ^(2)=6.51,P=0.011).After propensity score matching,there

关 键 词：休克 脓毒性 微生物学 病毒 重症监护病房 儿童 

分 类 号：R720.597[医药卫生—急诊医学]