小儿脓毒症和严重脓毒症发病情况单中心调查

A single-center survey on pediatric sepsis and severe sepsis

目的了解北京儿童医院PICU脓毒症/严重脓毒症的发病情况,探讨影响小儿严重脓毒症预后的相关危险因素。方法应用小儿危重病例评分和美国PICU入出院指南,对2008年1月1日—2008年12月31日期间入住PICU的所有危重患儿进行筛选(小儿脓毒症/严重脓毒症诊断采用2002年初在美国举行的国际儿科脓毒症联席会议确定的定义)。入选患儿填写调查表直至出院。纳入患儿3个月后通过电话随访了解出院后情况。结果本次研究共纳入危重患儿545例,脓毒症143例,严重脓毒症104例,现患率分别为26.2%和19.1%;住院病死率分别为0.7%、21.2%;90d病死率分别为1.4%、30.8%。3岁以下的婴幼儿病例占72.5%。肺炎为最主要的原发病,占47%。呼吸功能障碍(73.1%)为严重脓毒症患儿最常出现的器官功能障碍。存活的严重脓毒症患儿住PICU时间明显长于病死者,人均PICU费用及日均费用均高于危重患儿。多元逐步Logistic回归分析显示,小儿危重病例评分(PCIS评分)、毛细血管再充盈时间、呼吸功能障碍及低白蛋白血症是严重脓毒症患儿死亡危险因素。结论脓毒症/严重脓毒症是PICU中常见病,病死率高,住院费用消耗大;发病以婴幼儿常见,肺炎为最常见的原发病;PCIS评分、毛细血管再充盈时间、呼吸功能障碍及低白蛋白血症为严重脓毒症患儿的死亡危险因素。

Objective To detect the incidence and mortality of the pediatric sepsis / severe sepsis,and to investigate the risk factors for poor prognosis in these patients. Methods From Jan. 1 to Dec. 31,2008,all pediatric patients admitted to PICU in Beijing Children＇s Hospital were prospectively surveyed. Both Chinese pediatric critical care scoring system and American guidelines for PICU admission and discharge were applied for screening subjects. The diagnosis criteria of pediatric sepsis / severe sepsis were made according to the definition determined on the International Pediatric Sepsis Consensus Conference held in the United States in early 2002. The qualified subjects were surveyed by questionnaire until discharge. After three months,the subjects were followed up by telephone. Results In a total of 742 children were screened,545 cases were critically ill,143 cases （ 26.2% ） developed sepsis,and 104 cases （19.1%） deteriorated into a state of severe sepsis. Hospital mortality of severe sepsis was 21.2%,and that of sepsis was 0.7%. At the end of three months after discharged from hospital,mortality of severe sepsis was 30.8% ,and that of sepsis was 1.4%. Patients under 3-year-old accounted for 72.5%. Pneumonia was the most common primary disease. The respiratory dysfunctions in severe sepsis cases were most common organ dysfunction （73.1%）. In surviving patients with severe sepsis,the PICU stay was significantly longer than that in deceased patients,and the PICU costs and average per capita costs were higher than the critically ill patients. Multiple stepwise logistic regression analysis showed that pediatric critical illness score （ PCIS score） ,capillary refilling time,respiratory dysfunction and hypoalbuminemia were the risk factors for death. Conclusions Sepsis / severe sepsis are common in the PICU,which have high mortality,high hospital charges. Infants and young children were the most commonly affected. Pneumonia was the most common primary disease. PCIS score,capillary filling time,respiratory dysfunction and hypoalbuminemia were the risk factors for death.