儿童铜绿假单胞菌脓毒症的临床特征及预后相关因素分析

The Clinical Characteristics and Prognostic Factors of Pseudomonas Aeruginosa Sepsis in Children

目的探讨儿童铜绿假单胞菌(PA)脓毒症的临床特征及预后相关因素。方法收集2010年1月到2017年12月在我院住院治疗的46例PA脓毒症患儿,按疾病预后分死亡组与存活组,收集并分析其临床表现、辅助检查等资料,对可能影响预后的相关因素进行单因素分析及多因素Logistic回归分析。结果①46例PA脓毒症患儿中,男29例,女17例。年龄在6小时~14岁5月,其中年龄1岁以内占73.9%(34/46)。58.7%(27/46)存在院内感染、76.1%(35/46)有ICU治疗史和呼吸机使用史、23.9%(11/46)有血液滤过治疗、13%(6/46)有深静脉置管、6.5%(3/46)治疗过程中有使用糖皮质激素。②PA脓毒症临床特征多样,最常见感染部位为呼吸道,占56.5%(26/46),其次为消化道32.6%(15/46)、皮肤6.5%(3/46)等。存在多脏器功能障碍:呼吸系统功能障碍76.1%(35/46),凝血功能障碍54.3%(25/46)、肝功能障碍56.5%(26/46)、神经系统功能障碍54.3%(25/46)、感染性休克30.4%(14/46)肾功能障碍19.6%(9/46)。6.5%(3/46)患儿存在皮肤损害,主要表现为坏疽性脓疱疹。③34.8%(16/46)患儿死亡。单因素分析结果显示与预后不良相关的因素有基础疾病、凝血功能障碍、器官功能障碍数目、1h后抗菌治疗(P<0.05)。经多因素Logistic回归分析,提示器官功能障碍数目[OR=3.470,95%CI(1.222,9.855),P=0.020]、1h后抗菌治疗[OR=16.302,95%CI(1.923,138.229),P=0.010]是与预后不良相关的独立危险因素。结论儿童铜绿假单胞菌脓毒症多见于院内感染,好发于1岁以内婴幼儿,有类固醇激素治疗、使用呼吸机、有创操作、烧伤等基础疾病的患儿易感。其临床表现不典型,最常见呼吸系统感染,其次可见于消化道及皮肤感染等,可致多器官功能障碍,尤其是呼吸系统功能障碍。器官功能障碍数目、1h后抗菌治疗是PA脓毒症预后不良的独立危险因素。

Objective To explore the clinical characteristics and prognostic factors of Pseudomonas aeruginosa(PA)sepsis in children.Methods 46 patients were diagnosed as PA sepsis in our hospital from January 2010 to December 2017.The clinical features and laboratory findings were collected and further analyzed between death group and survival group.The risk factors related to poor prognosis were analyzed by Logistic regession.Results Among 46 children confirmed as PA sepsis,29 were males(63%)and 17 were females(37%).Most of the patients were under 1 year(73.9%,34/46).Hospital acquired infection accounted for 58.7%(27/46).Before PA infectoin,76.1%cases received mechanical ventilation,23.9%cases underwent blood purification treatment,and 6.5%patietns used glucocorticoids.As to the clinical features,respiratory tract was the most common site of infection(26/46,56.5%),followed by digestive tract(15/46,32.6%)and skin(3/46,6.5%).Respiratory dysfunction(35/46,76.1%),blood coagulation dysfunction(25/46,54.3%),hepatic dysfunction(26/46,56.5%),and nervous system dysfunction(25/46,54.3%)were the most common complications cause by PA infection.The death rate of Children PA sepsis was 34.8%(16/46).Risk factors associated with poor prognosis included underlying disease,coagulation dysfunction,the number of organ dysfunction and initiation of antibacterial treatment within 1h.Logistic analysis showed the number of organ dysfunction[OR=3.470,95%CI(1.222,9.855),P=0.020]and initiation of antibacterial treatment within 1h[OR=16.302,95%CI(1.923,138.229),P=0.010]as the independent risk factors.Conclusion Children with PA sepsis proned to occure in infants and young children udner 1 year old druing hospitalization.Children who received steroid hormone therapy,ventilator,invasive operation were susceptible to PA infection.Respiratory tract,digestive tract and skin were the most common site of infection.The number of organ dysfunction and initiation of antibacterial treatment within 1h were the independent risk factors for poor prognosis.