血管活性药物评分对儿童脓毒性休克的预后判断价值及护理要点

Prognostic value and nursing highlights of vasoactive inotropic score on septic shock in children

目的通过观察儿童脓毒性休克(SS)患儿VIS评分及相关炎症介质水平,探讨其对儿童脓毒性休克的预后判断价值及护理要点。方法纳入2012年1月—2017年12月温州医科大学附属第二医院PICU收治的儿童SS失代偿型患儿,依据患儿疾病的最终转归情况分为观察组(存活)和对照组(死亡)。其中观察组68例,对照组42例,对比2组患儿VIS、血乳酸(BL)水平及降钙素原(PCT)水平对疾病预后判断价值及护理要点,并分析观察组患儿血管活性药物评分(VIS)与BL及PCT的相关性。结果观察组与对照组患儿入院第一个24h的VIS(29.2±4.2vs.11.4±3.3)、BL水平[(4.7±1.6)mmol/Lvs.(5.9±2.1)mmol/L]及PCT水平[(7.8±1.5)ng/mlvs.(5.6±2.1)ng/ml]比较,差异均有统计学意义(均P<0.05)。观察组患儿VIS与BL(r=0.493,P<0.001)及PCT水平(r=0.574,P<0.001)均呈正相关。ROC曲线分析显示,以20.3为截点值,VIS对预判SS预后不良的敏感性为85.71%,特异性为72.06%,曲线下面积为0.804,优于BL及PCT水平。结论VIS对儿童SS的预后具有一定预判价值,护理工作在诊疗过程中亦有重要作用。

Objective By observing the VIS score and related inflammatory mediators in children with septic shock ( SS) ,the prognostic value and nursing highlights of septic shock in children were discussed,in order to provide reference for clinical diagnosis and treatment. Methods Children with SS decompensated children who were admitted to PICU from January,2012 to December,2017 in our hospital were divided into observation group ( survival) and control group ( death) according to the final outcome of the disease,with 68 patients in the observation group and 42 patients in the control group. The VIS,BL levels,and procalcitonin ( PCT) levels in the two groups were compared to determine the prognostic value of the disease and the nursing highlights. The correlation between VIS,BL,and PCT in the observation group was also analyzed. Results In the observation group,the first 24-hour VIS ( 29. 2 ± 4. 2 vs. 11. 4 ± 3. 3,t = 23. 36,P < 0. 01 ) ,BL level [( 4. 7 ± 1. 6) mmol /L vs. ( 5. 9 ± 2. 1) mmol /L,t = 3. 385,P < 0. 01 ]and PCT levels [( 7. 8 ± 1. 5) ng /ml vs. ( 5. 6 ± 2. 1) ng /ml,t = 5. 916,P < 0. 01 ]were significantly higher than those of the control group ( all P < 0. 05) . There was a statistically significant positive correlation between VIS and BL ( r = 0. 493,P < 0. 001) and PCT ( r = 0. 574,P < 0. 001) in the observation group. ROC curve analysis showed that with 20. 3 as the cutoff value,VIS had a sensitivity of 85. 71% and a specificity of 72. 06% for predicting poor prognosis of SS,and the area under the curve was 0. 804,which was better than BL and PCT. Conclusion VIS has a certain predictive value for the prognosis of children with SS,and nursing work also plays an important role in the process of diagnosis and treatment.