pSOFA评分联合AGI分级评估脓毒症患儿预后的价值  

Prognostic value of pSOFA score combined with AGI grade in children with sepsis

作　　者：钱新阳 王育民 QIAN Xinyang;WANG Yumin(Graduate School of Baotou Medical College,Baotou 014040,Inner Mongolia,China;Inner Mongolia Maternal and Child Health Hospital,Hohhot 010020,Inner Mongolia,China)

机构地区：[1]包头医学院研究生院,内蒙古包头014040 [2]内蒙古自治区妇幼保健院儿内科,内蒙古呼和浩特010020

出　　处：《中国现代医生》2025年第2期54-57,共4页China Modern Doctor

摘　　要：目的分析脓毒症合并急性胃肠损伤(acute gastrointestinal injury,AGI)患儿预后的影响因素,并讨论儿科序贯器官衰竭评估(pediatric sequential organ failure assessment,pSOFA)评分、AGI分级及二者联合对其预后的预测价值。方法选取2020年1月至2022年1月内蒙古自治区妇幼保健院收治的143例脓毒症合并AGI患儿作为研究对象,依据病情程度分为脓毒症组(n=103)和脓毒性休克组(n=40)。确诊脓毒症当天进行pSOFA评分、住院期间每日AGI评估并赋值,选取最高值与pSOFA评分相加得到联合评分。采用Logistic回归分析患儿预后的影响因素,采用受试者操作特征(receiver operating characteristic,ROC)曲线分析pSOFA评分、AGI分级及二者联合对预后不良的预测价值。结果脓毒性休克组患儿连续肾脏替代治疗、手术治疗、机械通气、便血、肠鸣音减弱或消失的例数及降钙素原水平均高于脓毒症组(P<0.05)。脓毒性休克组患儿的红细胞计数、血红蛋白、血小板计数均低于脓毒症组(P<0.05)。多因素Logistic回归分析显示,机械通气、手术治疗、血红蛋白浓度降低、pSOFA评分升高、AGI分级升高为患儿预后不良的独立危险因素(P<0.05)。ROC曲线分析结果显示,pSOFA评分联合AGI分级对患儿预后的预测价值高于二者单独的预测价值(P<0.05)。结论机械通气、手术、血红蛋白、pSOFA评分、AGI分级为脓毒症合并AGI患儿预后的影响因素,pSOFA评分联合AGI分级对预后不良有较高的预测价值。Objective To investigate the prognostic factors of acute gastrointestinal injury(AGI)in children with sepsis,and to explore the predictive value of pediatric sequential organ failure assessment(pSOFA)score,AGI grade and their combined for prognosis.Methods A total of 143 children with sepsis complicated with AGI in Inner Mongolia Maternal and Child Health Hospital from January 2020 to January 2022 were selected and divided into sepsis group(n=103)and septic shock group(n=40)according to the severity of disease.pSOFA score was obtained on the day when sepsis was diagnosed.AGI was evaluated every day during hospitalization.Multivariate Logistic regression was used to identify independent factors affecting the outcome.Receiver operating characteristic(ROC)curve was used to analyze predictive value of pSOFA score,AGI grade and their combination for poor prognosis.Results The number of patients who received continuous renal replacement therapy,surgery,mechanical ventilation,bloody stool,hypoactive bowel sound and procalcitonin concentration in septic shock group were higher than those in sepsis group(P<0.05).Red blood cell,hemoglobin and platelet in septic shock group were lower than those in sepsis group(P<0.05).Multivariate Logistic regression analysis showed that mechanical ventilation,surgery,decrease of hemoglobin,increase of pSOFA score and AGI grade were independent risk factors for poor prognosis in patients(P<0.05).ROC curve analysis showed that predictive value of pSOFA score combined with AGI grading for prognosis of patients was higher than that of them alone(P<0.05).Conclusion Mechanical ventilation,surgery,hemoglobin,pSOFA score and AGI grade are prognostic factors of sepsis complicated with AGI in children.pSOFA score combined with AGI grade has a high value in predicting poor prognosis.

关 键 词：儿科 脓毒症 急性胃肠损伤 

分 类 号：R72[医药卫生—儿科]