肺炎合并脓毒症73例临床特点分析

Clinical observations on children with pneumonia accompanying sepsis

目的通过测定各项炎症指标、检测病原体及分析预后与转归,探讨合并脓毒症对判断肺炎患儿病情轻重的意义。方法选取2008年1月至7月在中国医科大学附属盛京医院小儿呼吸急救内科病房住院的1个月至13岁的73例肺炎患儿为研究对象,将其按病情分为脓毒症组和非脓毒症组,所有患儿于入院24h内测定C-反应蛋白(CRP)、血糖、心肌酶及其他生化指标,并进行细菌培养。积极给予患儿抗生素及对症支持治疗,及时进行抗生素调整,动态观察患儿的器官衰竭情况。结果 (1)非脓毒症组器官衰竭的发生率为15.4%,其中无死亡病例,而脓毒症组患儿器官衰竭发生率为38.2%,两组之间的比较差异有统计学意义(P<0.05)。脓毒症组有4例发生了多脏器功能衰竭(MODS),1例发生了急性呼吸窘迫综合征(ARDS),且有5例为死亡病例。(2)非脓毒症组病例中,23.08%CRP升高,25.64%血乳酸升高,7.69%血糖升高。脓毒症组有85.29%CRP升高,73.53%血乳酸升高,58.82%血糖升高,两组之间炎症指标异常情况;发生率差异有统计学意义(P<0.01)。(3)非脓毒症组患者的细菌培养结果均为阴性,脓毒症组细菌培养阳性15例,其中痰细菌培养阳性12例(死亡1例),血细菌培养阳性3例(死亡2例)。结论肺炎合并脓毒症预后差,可以作为小儿肺炎预后评估的重要依据。

Objective To evaluate the value of pneumonia accompanying sepsis in evaluating patients condition by monitoring inflammatory factors, pathogen and prognosis. Methods A total of 73 children with pneumonia were divided into two groups ： sepsis group and non - sepsis group. CRP, blood glucose, lactic acid, creatine kinase and other factors, sputum bacterial culture and blood bacterial culture were evaluated in all the children. All the children were given antibi- otics, expectant treatment and support treatment. Observe the condition of organ function. Results （1） In non-sepsis group, the incidence rate of organ dysfunction was 15.4%, and no patient died. But in sepsis group, the incidence rate of organ dysfunction was 38.2%, and there were 4 MODS cases and lARDS case. Besides, 5 patients died in this group. The differences between two groups were significant （P 〈 0.05）. （2） In non-sepsis group, 23.08% of cases were with in- creased CRP, 25.64% with increased blood lactic acid and 7.69% with increased blood glucose. In sepsis group, there was 85.29% with increased CRP, 73.53% with increased blood lactic acid and 58.82% with increased blood glucose. The dif- ferences between two groups were significant （P 〈 0.01 ）. （3） In non-sepsis group, bacterium culture of all cases were negative. In sepsis group, there were 15 cases with positive bacterial culture in which 12 cases were sputum bacterial culture（ 1 case died） and 3 cases were blood bacterial cuhure（2 cases died）. Conclusion Cases of pneumonia accompanying sepsis have worse prognosis. It suggests thai pneumonia accompanying sepsis could be an important evidence in evaluating patients＇ condition and prognosis.