56例儿童脓毒症患者的临床分析

Clinical analysis on 56 children with sepsis

目的通过脓毒症与非脓毒症儿童对比分析,了解其临床特点及预后,为早期诊断和治疗提供依据。方法选择2009年1月至2013年12月十堰市中医院收治的56例脓毒症患儿（脓毒症组）和40例非脓毒症患儿（非脓毒症组）为研究对象,对其临床资料进行回顾性分析。结果脓毒症患儿组年龄为（3.05±2.15）岁,低于非脓毒症患儿组年龄（5.40±4.34）岁（t=3.50、P〈0.01）;3岁以下患儿占64.3%,高于非脓毒症患儿组的35.0%（χ^2=8.02、P〈0.0I）,差异均具有统计学意义;两组最常见的感染部位均为肺部,在多个部位感染的差异无统计学意义（JD〉0.05）。56例脓毒症患儿共分离出病原菌40株,革兰阴性菌、革兰阳性菌和真菌分别占57.5%、37.5%和5.0%。30.4%的脓毒症患儿有基础疾病,高于非脓毒症患儿（15.0%）（χ^2=4.21,户〈0.05）。脓毒症患儿组白细胞（WBC）、C-反应蛋白（CRP）、降钙素原（PCT）及D-二聚体（DD）水平显著高于非脓毒症组,血小板（PLT）计数显著低于非脓毒症组,其白细胞介素-6（IL-6）、IL-10、肿瘤坏死因子（TNF）-α及内毒素水平也显著高于非脓毒症组,差异均具有统计学意义（P均〈0.01）。脓毒症患儿组发生器官功能障碍者占35.7%（20例）,其中多器官功能障碍者占14.3%（8例）,病死率为5.4%（3例）,而非脓毒症患儿组发生单器官功能障碍者占5.0%（2例）,无死亡病例。结论儿童脓毒症以3岁以下婴幼儿居多,可累及多部位感染,最常见的感染部位为肺部,部分患儿有基础疾病,其WBC、CRP、PCT、DD和内毒素等炎性相关指标及IL-6、IL-10、TNF-α等炎症细胞因子水平显著升高,而PLT计数显著降低,在儿童SIRS的诊断中具有重要的临床意义。

Objective To investigate the clinical characteristics and the prognosis of children with sepsis,and to provide references for early diagnosis and treatment by comparative analysis of sepsis and nonsepsis.Methods The data of 56 children with sepsis（sepsis group） and 40 cases with non-sepsis（non-sepsis group） hospitalized in Shiyan Traditional Chinese Medicine Hospital from January 2009 to December 2013 were analyzed,retrospectively.Results The age of sepsis group was（3.05 ±2.15） years,significantly lower than（5.40 ± 4.34） years of non-sepsis group（t = 3.50,P 〈0.01）;patients under 3 years old in sepsis group accounted for 64.3%,significantly higher than that（35.0%） in non-sepsis group（χ^2= 8.02,P〈 0.01）.The most common sites of infection in the two groups were lungs,there was no significant difference in multiple sites of infection between the two groups（P all 〉0.05）.There were 40 strains of pathogenic bacteria isolated from 56 cases with sepsis,Gram negative bacteria,Gram positive bacteria and fungi accounted for 57.5%,37.5%and 5.0%,respectively.30.4%children with sepsis had underlying diseases,significantly higher than that of non-sepsis children（15.0%）（χ^2 = 4.21,P 〈0.05）.White blood cells（WBC）,C-reactive protein（CRP）,procalcitonin（PCT）,two D-dimer（DD） levels were significantly higher and platelet（PLT） count was significantly lower in sepsis group than those in non-sepsis group（P all 〈0.01）.The interleukin-6（IL-6）,IL-10,tumor necrosis factor（TNF）-α and endotoxin levels were also significantly higher than those in nonsepsis group（P all 〈0.01）.Organ dysfunction in sepsis group was 35.7%（20 cases）,in which multiple organ dysfunction was 14.3%（8 cases）,the fatality rate was 5.4%（3 cases）,while single organ dysfunction in nonsepsis group was 5.0%（2 cases）,no death occurred.Conclusions Most sepsis in children were less than 3years old,which could involve multiple parts infection.The most common infection sites were lungs,some patients have underlying diseases.The WBC,CRP,PCT,DD and endotoxin related inflammatory markers and IL-6,IL-10 and TNF-α inflammatory cytokines increased significantly,PLT count decreased significantly,which has important clinical significance to the diagnosis of child with sepsis.