影响PICU脓毒性休克患儿预后的单中心研究  

A single center study of influence on the prognosis of children with septic shock in PICU

作　　者：陈庆 陈建丽[1] 凌萍[1] 唐熔[1] 罗诗雨 罗艳[1] 王学鑫 林谊 王莎 Chen Qing;Chen Jianli;Ling Ping;Tang Rong;Luo Shiyu;Luo Yan;Wang Xuexin;Lin Yi;Wang Sha(Infection Department,Guiyang Maternal and Child Health Hospital,Guiyang 550000,China)

机构地区：[1]贵阳市妇幼保健院感染科,550000

出　　处：《中国小儿急救医学》2024年第11期856-860,共5页Chinese Pediatric Emergency Medicine

摘　　要：目的分析影响儿童重症监护病房脓毒性休克患儿预后的因素。方法回顾性收集2018年4月至2022年4月贵阳市妇幼保健院儿童重症监护病房收治的脓毒性休克患儿的临床资料,根据7 d转归分为死亡组和存活组,统计两组患儿的基本资料,比较入院第1小时乳酸、血管活性药物评分、抗生素开始使用时间、血钾、血钠、血钙、血清肌钙蛋白T、是否合并脓毒性脑病、第1小时内液体复苏量、丙氨酸转氨酶、肌酐、白细胞总数、C-反应蛋白及脑钠肽与预后的关系,并采用Logistic回归分析影响患儿死亡的风险因素。采用ROC曲线分析第1小时液体复苏量与预后的关系。结果(1)共纳入67例患儿,死亡19例,存活48例;(2)存活组患儿第1小时液体复苏量低于死亡组,差异有统计学意义(P<0.05);(3)ROC曲线分析显示,第1小时液体复苏最佳剂量截断值为25 mL/kg,其敏感度为57.9%,特异度为72.9%;(4)在单因素分析中,入院第1小时乳酸、复苏后早期乳酸、血清钙、血清肌钙蛋白T、丙氨酸转氨酶、是否合并脓毒性脑病、格拉斯哥昏迷评分、小儿危重病例评分,均是影响患儿7 d内死亡的危险因素(P<0.05);(5)多因素Logistic回归分析显示,血清钙(OR=1.435,P=0.001)及复苏后乳酸值(OR=0.040,P=0.021)是脓毒性休克死亡的独立风险因素。结论第1小时的液量复苏总量越多,病死率越高;血清钙、复苏后早期乳酸是影响患儿7 d内死亡的独立风险因素。ObjectiveTo analyze the prognostic factors of children with septic shock in the pediatric intensive care unit.MethodsThe clinical data of children diagnosed with septic shock in the pediatric intensive care unit of Guiyang Maternal and Child Health Hospital from April 2018 to April 2022 were retrospectively collected,and the children were divided into the death group and the survival group according to seven days regression.The basic data of the two groups were statistically compared,and the relationship between lactic acid,vasoactive-inotropic score one hour after admission,time of antibiotic initiation,serum potassium,serum sodium,serum calcium,serum troponin T,fluid resuscitation volume in the first hour,glutamyl aminotransferase,creatinine,total leukocyte count,C-reaction protein,brain natriuretic peptide were compared.The risk factors affecting the death of children were analyzed by Logistic regression.The relationship between fluid resuscitation volume in the first hour and prognosis was analyzed using the receiver operator characteristic(ROC)curve.Results(1)A total of 67 children were included,19 died and 48 survived.(2)The first-hour liquid resuscitation dose in the survival group was lower than that in the death group,and the difference was statistically significant(P<0.05).(3)The ROC curve showed that the optimal cut-off of the first-hour liquid resuscitation dose was 25 mL/kg,with a sensitivity of 57.9% and a specificity of 72.9%.(4)In unifactorial analysis,lactic acid in the first hour of admission,early lactic acid after resuscitation,serum calcium,serum troponin T,alanine aminotransferase,combined septic encephalopathy,Glasgow coma score,and pediatric critical illness score were all risk factors for death in children within seven days(P<0.05).(5)Multivariate Logistic regression analysis showed that serum calcium(OR=1.435,P=0.001)and lactic acid value after resuscitation(OR=0.040,P=0.021)were independent risk factors for death in septic shock.ConclusionThe higher the total fluid resuscitation in the

关 键 词：脓毒性休克 液体复苏 死亡 儿童 预后因素 

分 类 号：R720.597[医药卫生—急诊医学]