儿童脓毒症发生毛细血管渗漏综合征的临床危险因素分析

Clinical risk factors for capillary leak syndrome in children with sepsis

目的探讨脓毒症患儿出现毛细血管渗漏综合征(CLS)时的临床特点及相关危险因素。方法回顾分析384例脓毒症患儿的临床资料。其中一般脓毒症304例,严重脓毒症54例,脓毒性休克26例。根据是否发生CLS将病例分为非CLS组(356例)和CLS组(28例),将两组患儿的性别、年龄、营养不良、贫血、凝血功能障碍、白细胞计数、CRP、PCT、TNF、IL-1、IL-6、血糖、乳酸、PRISMⅢ评分、PICS评分、严重脓毒症及休克和器官功能衰竭≥3个等因素进行单因素分析,再将有统计学意义的指标作为自变量,进行多因素logistic回归分析。结果脓毒性休克、严重脓毒症和一般脓毒症组患儿CLS发生率分别为42.3%、20.1%及1.3%,差异有统计学意义(P<0.01)。贫血、凝血功能障碍、CRP、PCT>2 ng/mL、TNF、IL-1、IL-6、血糖、乳酸、PRISMⅢ评分、PICS评分、严重脓毒症及休克和MODS≥3个在非CLS组和CLS组间比较差异均有统计学意义(P<0.05);严重脓毒症及休克和PRISMⅢ评分为脓毒症患儿发生CLS的独立危险因素。结论脓毒症患儿病情越严重,PRISMⅢ评分越高,发生CLS的比例越高。故对于严重脓毒症和PRISMⅢ评分越高的患儿,早期监测感染标志物及血糖等相关结果,可能有助于早期识别CLS及积极干预,降低儿童脓毒症合并CLS的病死率。

Objective To investigate the clinical features of capillary leak syndrome （CLS） in children with sepsis, and to analyze its risk factors. Methods Clinical data of 384 children with sepsis was studied retrospectively. They included 304 cases of general sepsis, 54 cases of severe sepsis and 26 cases of septic shock, and were divided into nonCLS （ n = 356） and CLS groups （ n = 28）. Univariate analysis was performed for each of the following variables ： sex, age,malnutrition, anemia, coagulation disorders, white blood cell count, C-reactive protein （CRP）, procalcitonin （PCT）, tumor necrosis factor （TNF）, interleukin （IL）-1, IL-6, blood glucose, lactic acid, Pediatric Risk of Mortality （PRISM）Ⅲ score, pediatric critical illness score （PICS）, severe sepsis and number of failed organs ≥3. The statistically significant variables （as independent variables） were subjected to multivariate logistic regression analysis. Results The incidence rate of CLS in children with septic shock, severe sepsis and general sepsis were 42.3% , 20.1% and 1.3% , respectively, with significant differences among them （P 〈 0.01 ）. There were significant differences in anemia, coagulation disorders,CRP, PCT 〉 2 ng/mL, TNF, IL-1, IL-6, blood glucose, lactic acid, PRISM III score, PICS and number of failed organs ≥3 between the non-CLS and CLS groups （P 〈 0.05 ）. Severe sepsis/shock and PRISM Ⅲ score were the independent risk factors for CLS in children with sepsis. Conclusions The severity of sepsis and PRISM Ⅲ score are positively correlated with the incidence of CLS in children with sepsis. Early monitoring of such factors as infection markers and blood glucose in children with severe sepsis and high PRISM Ⅲ score may contribute to early diagnosis and effective intervention,thus reducing the mortality from CLS in children with sepsis.