脓毒症致毛细血管渗漏综合征35例

Clinical Analysis of 35 Children with Capillary Leak Syndrome Caused by Sepsis

目的观察脓毒症患儿并毛细血管渗漏综合征(CLS)的临床特点。方法回顾性分析2001-2010年在本院住院治疗的35例脓毒症并CLS患儿的临床表现、辅助检查特点及治疗、预后情况,对常见致病菌进行药物敏感试验以观察其对抗生素的敏感性,指导临床用药。结果 CLS的发病率有逐年上升趋势。35例患儿均有全身急性进行性水肿及血压下降,呼吸困难27例,意识障碍15例,少尿8例,肉眼血尿5例,肾功能不全12例,均存在低清蛋白血症,尿常规均可见蛋白尿及镜下血尿,胸腔积液28例,腹腔积液26例,心包积液10例。引起儿童脓毒症并CLS最常见的致病菌为革兰阴性杆菌(24例,占85.7%),其对头孢哌酮/舒巴坦钠、亚胺培南、呋喃妥因耐药率低(<15%)。CLS治疗中积极控制感染和补充胶体液尤为关键。结论 CLS具有特殊的病理生理特点和临床表现,只有进行正确的诊断、细致的监测及恰当的治疗才能最大程度地提高治疗效果和改善预后。

Objective To investigate the clinical characteristics of sepsis with capillary leak syndrome（CLS） in children in order to enhance our understanding of it. Methods Clinical symptoms,laboratory examination,treatment and prognosis in 35 hospitalized patients suffered from sepsis with CLS from 2001 to 2010 were analyzed retrospectively.The antibiotic resistance to the most common pathogens was determined by the antimicrobial susceptibility test in order to guide clinical medications. Results CLS showed an increasing trend.All of them had acute and progressive edema and low blood pressure,27 cases had dyspnea,15 cases had conscious disturbance,8 cases had oliguria,5 cases had gross hematuria,and 12 cases had renal insufficiency.All of them had hypoalbuminemia,proteinuria and hematuria,28 cases had pleural effusion,26 cases had peritoneal effusion and 10 cases had pericardial effusion.Gram-negative bacilli were the most common pathogens caused by sepsis with CLS（24 cases,85.7%）.The resistance rates of cefoperazone/sulbactam,imipenem and furadantin to Gram-negative bacilli were low（〈15%）.Active control of infection and supplement of colloidal liquid were crucial. Conclusions Since CLS has special pathological,physiological and clinical characteristics,the physicians should make a correct diagnosis,careful monitor and suitable treatments to improve the effect of treatments and prognosis as far as greatest possibility.