儿童脓毒症临床特点及预后相关因素分析

Clinical characteristics and risk factors associated with prognosis of sepsis in children

摘要:

目的：分析儿童脓毒症的临床特点及预后，为其早期诊断、治疗提供依据。方法：选择2007年1月至2012年10月在重庆医科大学附属儿童医院住院的105例脓毒症患儿为研究对象，对其临床资料进行回顾性分析。结果：105例脓毒症患儿，男74例（70.5%），女31例（29.5%），3岁以内占65.7%。病程中临床表现多样化，易累及多部位感染，可导致多器官功能障碍综合征（multiple organ dysfunction syndrome，MODS）64.8%。最常见的感染部位依次为肺部（92.4%）、皮肤软组织（35.2%）、颅内（32.4%）；最常见的器官功能障碍依次为：呼吸系统（54.3%）、血液系统（50.5%）、肝脏（44.8%）；最常见的原发感染灶依次为肺部（41.9%）、皮肤软组织（21.0%）、消化系统（17.1%）。单因素分析显示器官功能障碍数目（Z=-5.940，P=0.000）、脓毒性休克（χ2=8.531，P=0.003）、白细胞计数（white blood count，WBC）（Z=-2.100，P=0.036）、血小板计数（platelet count，PLT）（Z=-2.925，P=0.003）、降钙素原（procalcitonin，PCT）（Z=-2.125，P=0.034）、D二聚体（D-dimer，DD）（Z=-3.748，P=0.000）、电解质紊乱（χ2=5.899，P=0.015）、入院留取标本1 h后抗菌治疗（χ2=4.594，P=0.032）为影响脓毒症预后的因素。经logistic回归模型检验，仍然与预后相关的因素为器官功能障碍数目（OR=4.256，95%CI=0.112~0.493）及1 h后抗菌治疗（OR=5.027，95%CI=0.048~0.824）。结论：儿童脓毒症中3岁以内婴幼儿居多。临床表现多样化，易累及多部位感染，可导致MODS，最常见的器官功能障碍及感染部位均为呼吸系统，最常见的原发感染灶为肺部。器官功能障碍数增多及1 h后抗菌治疗为导致预后不良的因素。

Abstract:

Objective：To analyze the clinical characteristics and prognosis of sepsis in children and to provide references for early di－agnosis and treatment. Methods：A retrospective study was performed on 105 patients with sepsis hospitalized in Children’s Hospital of Chongqing Medical University from January 2007 to October 2012. Results：There were 74 males（70.5%） and 31 females（29.5%），and most of them were under 3 years old（65.7%）. The clinical manifestations varied. Sepsis could result in multiple sites of infection and organ dysfunction syndrome（MODS）（64.8%）. The most common sites of infection were lung（92.4%），skin and soft tissue（35.2%），and intracalvarium（32.4%）. The main dysfunctional organs were respiratory system（54.3%），hematologic system（50.5%） and liver（44.8%）. The most common initial site of infection were lung（41.9%），skin and soft tissue（21.0%），and digestive system（17.1%）. In the univariate analysis，variables significantly associated with prognosis were increased dysfunctional organs（Z=-5.940，P=0.000），septic shock（χ2=8.531，P=0.003），white blood count（Z=-2.100，P=0.036），platelet count（Z=-2.925，P=0.003），serum procalcitonin（Z=-2.125，P=0.034），serum D-dimer（Z=-3.748，P=0.000），electrolyte disturbance（χ2=5.899，P=0.015），anti-infective therapy at one hour after admitting to hospital（χ2=4.594，P=0.032）. And the logistic regression model showed increased dysfunctional organs and anti-infective therapy at one hour after admitting to hospital were risk factors associated with prognosis. Conclusion：Most patients with sepsis in children are less than 3 years old. The clinical manifestations of sepsis vary and sepsis could result in MODS. The most com－mon dysfunctional organ and infection site is respiratory system and the most common initial infection site was lung. Increased dys－functional organs and anti-infective therapy at one hour after admitting to hospital are the risk factors for death.