儿童脓毒症致多器官功能不全综合征的临床分析

Clinical analysis of multiple organ dysfunction syndrome caused by sepsis in children

目的了解儿童脓毒症致多器官功能不全综合征(MODS)的临床特点及其对预后的影响。方法 2011年8月至2016年6月禹州市人民医院PICU病房收治脓毒症患儿204例,分析其累及器官的情况,随访终点事件(90d死亡或难免死亡),行趋势χ~2检验、多因素Cox比例风险回归和Kaplan-Meier法生存分析。结果 (1)204例脓毒症患儿共发生MODS者83例,发生率40.69%(95%CI:33.89%~47.48%);不同年龄患儿的MODS发生率分别是:2d至1个月68.75%(11/16),>1个月至1岁55.10%(27/49),>1~5岁39.62%(21/53),>5~12岁32.61%(15/46),>12~17岁22.50%(9/40),随着年龄的增大MODS的发生率逐渐降低(P<0.05)。(2)累及器官的频次依次是肺61例(29.90%)、心52例(25.49%)、血液41例(20.10%)、神经36例(17.65%)、胃肠19例(9.31%)和肾12例(5.88%)。发生2个、3个、≥4个器官功能不全者分别为19例(22.89%)、46例(55.42%)和18例(21.69%)。(3)无MODS、2个、3个和≥4个器官功能不全患儿的90d生存率分别是87.6%、63.2%、41.3%和11.1%,Log Rank(Mantel-Cox)检验,χ~2=92.59,P=0.000。Cox比例风险回归校正了年龄、氧合指数等混杂因素的干扰后,MODS仍然是影响患儿预后的显著因素,MODS的HR=2.573,6.579,12.699,P<0.05。结论低龄儿童是脓毒症并发MODS的高危人群,最易受累的靶器官是肺脏、心脏和血液。MODS独立影响患儿90d生存率,早期监测和预防MODS,切断MODS恶性循环,可望改善患儿预后。

Objective To understand the clinical characteristics and prognosis of multiple organ dys- function syndrome（MODS） caused by sepsis in children. Methods This study included 204 children with sepsis hospitalized to PICU in Yuzhou People＇s Hospital from August 2011 to June 2016,and their involved organs were analyzed; the end-point events（90d death or inevitable death） were followed up. Trend Chi- square test, multiple Cox proportional hazards regression and survival analysis （Kaplan-Meier methods） were performed. Results （1）The incidence of MODS was 83 cases[40.69%（95%CI：33.89%-47.48%）]in204 children with sepsis. The incidence rate of MODS was 68.75%（11/16） ,55.10%（27/49） ,39.62%（21/53）, 32.61%（15/46） and 22.50%（9/40） for the children at the age of 2 d to 1 month,〉1 month to 1 year,〉1 to 5 years, 〉5 to 12 years and 〉 12 to 17 years,with significant differences among children at different ages （P〈0.05）. （2）The frequency order of involved organs were lung（61 cases,29.90%） ,heart（52 cases, 25.49%）, blood system （ 41 cases, 20. 10%）, nervous system （36 cases, 17. 65 %）, gastrointestinal tract （ 19 cases, 9. 31% ） and kidney（12 cases, 5. 88 % ）. The incidence of dysfunction in 2,3 and ≥4 organs was 19 cases（22.89 % ）, 46 cases（55. 420/00） and 18 eases（21. 69%）,respectively. （3）The 90d survival rate of the children with non- MODS,2-,3- and ≥ organ dysfunction were 87.6%,63.2%,41.3% and 11.1%,respectively,x^2=92.59, P： 0. 000. After adjusting for age, oxygenation index, etc, multiple Cox proportional hazards regression showed that MODS was an independent factor of prognosis, HR= 2. 573,6. 579,12. 699, P〈0.05. Conclu- sion Young children are the high-risk population of MODS caused by sepsis. The main dysfunctional or- gans were lung,heart and blood system. MODS are the independent factors influencing the 90d survival rate of children with sepsis. Early detection,prevention and cutting off the transmission vicious circle of MODS are important to improve the outcome of ehild patients.