儿童重症医学科脓毒症发病及死亡相关危险因素临床分析

Investigation on clinical cases and die cases risk factor with sepsis in pediatric intensive care unit

目的探讨脓毒症在儿科重症监护室的发生情况以及死亡危险因素。方法收集脓毒症患儿756例资料,对脓毒症、严重脓毒症、脓毒性休克的发生率、病死率及其小儿危重病例评分(PCIS)、年龄因素、心肺复苏、机械通气治疗情况、病原菌检测以及死亡相关危险因素进行Logistic多因素分析。结果2596例危重患儿中,脓毒症患儿756例,发生率29.1%(756/2596)。其中严重脓毒症和脓毒性休克253例,发生率33.5%(253/756);心肺复苏213例,发生率28.2%(213/756);756例患儿中221例进行机械通气治疗,发生率29.2%。58例死亡,病死率26.2%(58/221)。呼吸机治疗时间15 208h,平均171.17h。患儿年龄分布以≤3岁最多,共计466例,占61.6%(468/756)。呼吸系统疾病是脓毒症最常见的感染性原发病(69.9%,538/756),细菌感染占脓毒症明确病原学的75%(471/756),其中G+菌和G-菌感染分别为54.76%和44.35%。死亡105例,病死率13.8%(105/756);死亡患儿平均年龄0.79岁。放弃治疗、自动出院95例,自动出院率37.6%。死亡相关因素为PCIS评分与机械通气两项指标,死亡病例PCIS评分显著低于存活患儿。结论脓毒症是PCIU较为常见的疾病,发生率高,患儿年龄越小,PCIS评分越低,病死率越高;如出现呼吸心跳骤停,需要机械通气治疗,则治疗难度更大,严重影响患儿的预后。须重视脓毒症的早期诊断,提高治疗效果,降低危重患儿的病死率。

Objective To investigate the cases and die cases risk factor with sepsis in pediatric intensive care unit. Methods The clinical data of 756 intensive care unit cases were collected and analyzed from January 2007 to May 2012 in Pediatric intensive care unit in Guiyang Children＇s Hospital. The incidence and mortality of systemic inflammatory response syndrome （SIRS）, sepsis, severe sepsis and septic shock, as well as the relationship between them, and age, were studied. Results A total of 2596 critically ill care of PICU were enrolled, 745 developed sepsis, of whose 105 died. The morbidity of sepsis for all in critically ill patients in PICU was 29. l~//00 （756/2596） and the mortality was 13.8o//00 （105/756）. The morbidity of severe sepsis and septic shock in PICU was 33. 50//00 （253/756）, The morbidity of CPR （cardio-pulmonary resuscitation） cares in PICU was 28.2o//00 （213/756）. The proportion of less than 3 years old was 61.9% （468/756）. Respiratory system diseases （69.9%, 538/ 756） were the underlying primary infections diseases of sepsis. Bacterial etiology accounted for 75% （471/756）of the cases with sepsis with definite etiological test results. The proportion gram-positive bacteria and garm-negative bacteria were 54.76% and 44.35%, respectively. Multiple stepwise logistic regression analysis showed that depressed PCIS and use of mechanical ventilation were the risk factors for death. Conclusion Sepsis is common and high morbidity in pediatric intensive care unit. Younger are more susceptible to develop it and carry a poor prognosis. More attention should be given to sepsis in patient intensive care unit.