新生儿感染性休克与疾病危重度评分及多脏器功能损害的相关研究

The relationship between neonatal septic shock,critical-scoring-system and multiple organ dysfunction syndrome

目的通过对新生儿感染性休克死亡病例分析,探讨新生儿感染性休克与新生儿疾病危重病例评分及多脏器功能损害(MODS)间的关系。方法选择新生儿感染性休克死亡病例共22例。根据新生儿休克分度、新生儿疾病危重病例评分及MODS诊断标准分别进行统计分析。结果(1)22例中以出生3d内发病为多(68%),并多于入院后3d死亡(86%)。原发疾病以感染性肺炎为主(68%),次为败血症(27%)。(2)入院当天作疾病危重度评分,22例均属危重(70～80分)或极危重病例(60-70分)。且多数患儿(8696)已处于极危重状态。(3)22例中,21例有1～4个脏器功能衰竭,以1～2个脏器功能衰竭为多见(82%)。最常见的脏器功能衰竭发生在呼吸系统(8696)。结论新生儿感染性休克原发病以感染性肺炎为主,入院当天疾病危重度评分均属危重或极危重病例,故若能及早开展新生儿危重度评分。必能在发病早期发现危重病例而且对感染性休克的诊断有一定提示作用。新生儿感染性休克中,脏器功能衰竭常见于呼吸系统,尽管仅合并一个脏器功能衰竭,往往亦提示预后严重。

Objective To analyze death cases of neonatal septic shock and to explore the relationship between it and critical-scoring-system （CSS） for neonatal disease and multiple organ dysfunction syndrome （MODS）. Methods Twenty-two death cases of neonatal septic shock were analyzed according to degree of shock, neonatal CSS and diagnostic criteria of MODS. Results Most of 22 cases were ill within 3 days after birth （68%） and dead within 3 days after admission （86%）. The major original disease was pneumonia （68 % ）, followed by sepsis （27 % ）. All patients were performed CSS during first day of admission. All the cases were serious （score 70-80） or extremely serious （score 60- 70） and most cases were extremely serious （86 % ）. Twenty-one cases showed organ dysfunction failure, and furthermore, one to two organ dysfunction failure were more common than three to four organ dysfunction failure. Most common organ dysfunction were found in respiratory system （86 % ）. Conclusion The major original disease of neonatal septic shock is infectious pneumonia. The scores of CSS are within the range of critical or extremely critical illness during first day of admission. If CSS can be applied earlier, it will be more helpful. Organ dysfunction failure usually appears in respiratory system. Organ dysfunction failure, even in only one organ, usually predicts a poor outcome.