脓毒性休克患儿临床特征与病原构成多中心研究  

A multicenter retrospective study on clinical features and pathogenic composition of septic shock in children

作　　者：刘刚[1] 许峰[2] 任宏[3] 张晨美[4] 李莺[5] 成怡冰 陈宇萍 段红年 刘春峰[8] 靳有鹏 陈森[10] 王晓敏[11] 孙俊怡 党红星[2] 徐香芝[4] 朱秋皎[5] 王向蝶 刘鑫惠 刘月 胡杨[8] 王伟 艾奇[10] 高恒妙[1] 樊超男[1] 钱素云[1] Liu Gang;Xu Feng;Ren Hong;Zhang Chenmei;Li Ying;Cheng Yibing;Chen Yuping;Duan Hongnian;Liu Chunfeng;Jin Youpeng;Chen Sen;Wang Xiaomin;Sun Junyi;Dang Hongxing;Xu Xiangzhi;Zhu Qiujiao;Wang Xiangdie;Liu Xinhui;Liu Yue;Hu Yang;Wang Wei;Ai Qi;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 Critical Care,Children′s Hospital of Chongqing Medical University,Chongqing 400014,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,Children′s Hospital,Zhejiang University School of Medicine,Hangzhou 310001,China;Department of Pediatric Intensive Care Unit,Children′s Hospital Affiliated to Soochow University,Suzhou 215025,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,Shengjing Hospital of China Medical University,Shenyang 110134,China;Department of Pediatric Intensive Care Unit,Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Department of Hematology,Tianjin Children′s Hospital,Tianjin 300074,China;Department of Pediatric Intensive Care Unit,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]重庆医科大学附属儿童医院重症医学科,重庆400014 [3]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 [4]浙江大学医学院附属儿童医院重症医学科,杭州310001 [5]苏州大学附属儿童医院重症医学科,苏州215025 [6]河南省儿童医院重症医学科,郑州450018 [7]保定市儿童医院重症医学科,保定071051 [8]中国医科大学附属盛京医院儿童重症医学科,沈阳110134 [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]天津市儿童医院血液科,天津300074 [11]天津市儿童医院重症医学科,天津300074

出　　处：《中华儿科杂志》2024年第11期1083-1089,共7页Chinese Journal of Pediatrics

基　　金：首都临床诊疗技术研究及转化应用项目(Z211100002921063)。

摘　　要：目的了解我国儿童重症监护病房脓毒性休克患儿主要临床特征、病原构成和预后。方法多中心回顾性队列研究。回顾性收集我国10家医院2018年1月至2021年12月收治于儿童重症监护病房脓毒性休克患儿的病例资料,分析其临床特征、病原构成和预后。根据是否存在恶性肿瘤基础病和预后将患儿分为恶性肿瘤组和非恶性肿瘤组,存活组和死亡组,采用两独立样本t检验、Mann-WhitneyU检验和χ^(2)检验比较组间临床特征和预后情况,利用多因素Logistic回归分析死亡相关危险因素。结果共纳入脓毒性休克患儿1247例,其中男748例(59.9%),年龄3.1(0.9,8.8)岁,住院病死率23.2%(289例)。总体病原阳性率为68.2%(851例)。共获得阳性病原体1229个,754个(61.4%)为细菌,305个(24.8%)为病毒。全部细菌中,革兰阴性菌484个(64.2%),前2位为铜绿假单胞菌[108个(22.3%)]和肠杆菌[102个(21.1%)];革兰阳性菌270个(35.8%),前2位为链球菌属[88个(32.6%)]和葡萄球菌[65个(24.1%)]。病毒中,前3位为流感病毒[86个(28.2%)]、EB病毒[53个(17.4%)]、呼吸道合胞病毒[46个(15.1%)]。与非恶性肿瘤组相比,肿瘤组患儿更年长,第三代小儿死亡危险(PRISMⅢ)和儿童序贯器官衰竭评分(pSOFA)均更高[7.9(4.3,11.8)比2.3(0.8,7.5)岁、22(16,26)比16(10,24)分、10(5,14)比8(4,12)分、Z=11.32、0.87、4.00,均P<0.05],且病原阳性率和住院病死率均更高[77.7%(240/309)比65.1%(611/938),29.7%(92/309)比21.0%(197/938),χ^(2)=16.84、10.04,均P<0.05]。病死组PRISMⅢ评分、pSOFA评分均更高[16(22,29)比14(10,20)分,8(12,15)比6(3,9)分,Z=4.92、11.88,均P<0.05],且存在肿瘤性疾病、病原阳性率和有创机械通气比例均高于存活组[29.7%(87/289)比23.2%(222/958),77.8%(225/289)比65.4%(626/958),73.7%(213/289)比50.6%(485/958),χ^(2)=5.72、16.03、49.98,均P<0.05]。PRISMⅢ和pSOFA评分、存在恶性肿瘤疾病均与病死相关(OR=1.04、1.09、0.67,95%CI 1.01~1.05、1.04~1.12、0.47~0.ObjectiveTo investigate the clinical features,pathogen composition,and prognosis of septic shock in pediatric intensive care units(PICU)in China.MethodsA multicenter retrospective cohort study.A retrospective analysis was conducted on the clinical data of children with septic shock from 10 hospitals in China between January 2018 and December 2021.The clinical features,pathogen composition,and outcomes were collected.Patients were categorized into malignant tumor and non-malignant tumor groups,as well as survival and mortality groups.T test,Mann Whitney U test or Chi square test were used respectively for comparing clinical characteristics and prognosis between 2 groups.Multiple Logistic regression was used to identify risk factors for mortality.ResultsA total of 1247 children with septic shock were included,with 748 males(59.9%)and the age of 3.1(0.9,8.8)years.The in-patient mortality rate was 23.2%(289 cases).The overall pathogen positive rate was 68.2%(851 cases),with 1229 pathogens identified.Bacterial accounted for 61.4%(754 strains)and virus for 24.8%(305 strains).Among all bacterium,Gram negative bacteria constituted 64.2%(484 strains),with Pseudomonas aeruginosa and Enterobacter being the most common;Gram positive bacteria comprised 35.8%(270 strains),primarily Streptococcus and Staphylococcus species.Influenza virus(86 strains(28.2%)),Epstein-Barr virus(53 strains(17.4%)),and respiratory syncytial virus(46 strains(17.1%))were the top three viruses.Children with malignant tumors were older and had higher pediatric risk of mortality(PRISM)Ⅲscore,paediatric sequential organ failure assessment(pSOFA)score(7.9(4.3,11.8)vs.2.3(0.8,7.5)years old,22(16,26)vs.16(10,24)points,10(5,14)vs.8(4,12)points,Z=11.32,0.87,4.00,all P<0.05),and higher pathogen positive rate,and in-hospital mortality(77.7%(240/309)vs.65.1%(611/938),29.7%(92/309)vs.21.0%(197/938),χ^(2)=16.84,10.04,both P<0.05)compared to the non-tumor group.In the death group,the score of PRISMⅢ,pSOFA(16(22,29)vs.14(10,20)points,8(12,15)vs.6(3,9)points,Z=4

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]