PICU儿童急性胃肠损伤的分级、预后及原因探讨

The classification, prognosis and causes of acute gastrointestinal injury in PICU children

目的探讨我院PICU患儿急性胃肠损伤的分级、预后及原因。方法回顾性收集我院PICU 2015年1月至2018年4月收治的患儿急性胃肠损伤(acute gastrointestinal injury,AGI)的发生率,根据AGI严重程度分为AGIⅠ~Ⅳ级,观察比较4组重症患儿的临床特点、28 d死亡情况、小儿危重病例评分、儿童器官功能障碍评分2(PELOD-2)、机械通气率。结果符合纳入标准及资料完整的有220例,其中AGIⅠ~Ⅳ级的例数依次为66例(30.0%)、97例(44.1%)、37例(16.8%)、20例(9.1%)。根据发病原因分为原发性与继发性,分别为149例(67.7%)、71例(32.3%)。男女比例、PICU住院时间、总住院时间在4组中差异无统计学意义(P>0.05);而发病年龄中位数(月),4组分别为3(1,15)、11(2,24)、11(2,36)、4(0.5,11.5),差异有统计学意义(P<0.05)。AGI总28 d病死率为16.36%,Ⅰ~Ⅳ级分别占0、0、13.2%、3.2%,小儿危重病例评分与PELOD-2在4组比较差异有统计学意义(P<0.05)。AGIⅢ级81.1%为继发性,AGIⅣ级100%为原发性。结论PICU患儿易发生急性胃肠损伤,以AGI Ⅰ、Ⅱ级多见,AGI分级与预后相关,分级越高,预后越差。AGIⅢ级预后最差,这与病因相关。

Objective To investigate the classification, prognosis and causes of acute gastrointestinal injury(AGI) in PICU patients in our hospital. Methods Patients were included if they had been hospitalized in PICU at least 24 h before the AGI diagnosis from January 2015 to April 2018.Patients were classified according to severity of gastrointestinal dysfunction.Clinical characteristics, pediatric critical illness scores, pediatric logistic organ dysfunction score 2 and 28-day mortality, as well as mechanical ventilation were recorded. Results A total of 220 patients were enrolled.AGIⅠ-Ⅳ groups included 66(30.0%), 97(44.1%), 37(16.8%)and 20(9.1%) patients, respectively, while primary AGI and secondary AGI included 149(67.7%) and 71 (32.3%)patients, respectively.There was no significant difference among four groups in gender, hospitalization time in PICU and total hospitalization time (P>0.05), but there were significant differences in median age, pediatric critical illness scores, pediatric logistic organ dysfunction score 2 and proportion of mechanical ventilation(P<0.05). Median age(month) was 3 (1, 15), 11 (2, 24), 11 (2, 36), and 4 (0.5, 11.5), respectively in AGI Ⅰ-Ⅳ groups.The total 28-day mortality rate of AGI Ⅰ-Ⅳ groups accounted for 0, 0, 13.2% and 3.2%, respectively. Conclusion Patients in PICU are prone to AGI.AGIⅠand AGI Ⅱare common.The prognosis is associated with classification of AGI.The higher grades of AGI are, the worse prognosis is.The prognosis of AGI Ⅲ is the worst, because of different causes.