儿童无发热脓毒性休克的临床特征

Clinical features of afebrile septic shock in children

脓毒症是危重症儿童最主要的死亡原因,其中发热或低体温是脓毒症的一个重要体征,是临床医师早期诊断的重要依据之一。然而儿童中也会罕见的发生无发热脓毒性休克的情况,其病情隐匿,进展迅速,临床医师易误诊、漏诊,延误治疗时机。本文通过回顾三例儿童无发热脓毒性休克病例,结合相关文献,发现化疗后骨髓抑制期及长期应用糖皮质激素的免疫抑制患儿是儿童无发热脓毒性休克其高危因素,而单核细胞免疫功能受损可能是无发热脓毒症形成的机制。及时地进行感染指标监测及感染原的检查,早期使用抗生素、液体复苏及器官功能维护治疗是改善预后的关键。

Sepsis is the most important cause of death in children with serious disease.Fever or hypothermia is an important characteristic of sepsis,which is one of the important evidences for clinicians to diagnose early.However,afebrile septic shock may occur rarely in children.And its symptoms are hidden and progress rapidly.It is easy for clinicians to miss diagnosis and delay the timing of treatment.This article reviews three cases of afebrile septic shock in children,discovering that the period of myelosuppression after chemotherapy and long-term use of glucocorticoid immunosuppression are high-risk factors,and the impaired function of monocyte may be the mechanism of its formation.Timely measuring of infection indicators and inspection of infectious agents,early use of antibiotics,fluid resuscitation and organ function maintenance treatment are the keys to improve the prognosis.