婴幼儿脓毒症临床特征与预后危险因素分析

Analysis of clinical features and prognostic risk factors of infantile sepsis

目的探讨婴幼儿脓毒症临床特征,分析其预后危险因素。方法 116例脓毒症患儿作为研究对象,采用回顾性分析和病例对照方法对患儿的临床特征、发病状况、预后进行分析,依照患儿随访情况将其分为存活组(106例)与死亡组(10例),采用单因素分析和Logistic回归分析方法对脓毒症预后危险因素进行分析。结果本组116例脓毒症患儿中,非危重患儿102例,极危重+危重患儿14例(包括多器官功能不全11例、脓毒性休克7例,其中4例合并多器官功能不全和脓毒性休克),死亡10例[原发部位:肺部7例(70.00%),中枢神经系统2例(20.00%),消化道1例(10.00%)]。两组患儿的入院前发热时间、住院时间、年龄、非危重率、脏器受累数≥3个发生率、低血糖发生率、应激高血糖发生率比较,差异均具有统计学意义(t=6.347、25.829、7.721,χ~2=47.586、17.510、9.005、17.990,P<0.05)。多因素Logistic回归分析结果显示,脓毒症严重程度和脏器受累数是导致婴幼儿死亡的独立危险因素(P<0.05)。结论婴幼儿脓毒症多见1岁以下婴幼儿,具有较高病死率,呼吸道和消化道是主要的原发感染病灶;婴幼儿脓毒症程度越重、受累器官数越多则患儿承受的死亡风险就越大。

Objective To explore the clinical features of infantile sepsis, and analyze its prognostic risk factors. Methods A total of 116 sepsis infants as study subjects, and their clinical characteristics, onset condition and prognosis were analyzed by retrospective analysis and case-control design. Infants were divided by followup status into survival group（106 cases） and death group（10 cases）. Sepsis prognostic risk factors were analyzed by single factor analysis and Logistic regression analysis method. Results Among 116 sepsis infants, there were 102 non critical cases, 14 extremely critical and critical cases（including 11 multiple organ dysfunction cases, 7 septic shock cases, with 4 multiple organ dysfunction cases complicated with septic shock cases）, and 10 death cases [primary site： 7 cases（70.00%） in lung, 2 cases（20.00%） in central nervous system, 1 case（10.00%） in digestive tract]. Both groups had statistically significant difference in fever time before admission, hospital stay time, age, non critical rate, incidence of ≥ 3 organs involved, incidence of hypoglycemia, and incidence of stress hyperglycemia（t=6.347, 25.829, 7.721, χ2=47.586, 17.510, 9.005, 17.990, P〈0.05）. Multi-factor Logistic regression analysis results showed that sepsis severity and number of organs involved were independent risk factors for death in infants and children（P〈0.05）. Conclusion Infantile sepsis is common in infants under 1 year old, with high mortality, and respiratory and digestive tract infection are the main primary lesions. The severer degree of infantile sepsis and more number of organs involved, the higher death risk the children subject to.