儿童脓毒性休克的预后影响因素分析

Analysis of prognostic factors of septic shock in children

目的探讨儿童重症监护病房(PICU)中儿童脓毒性休克患者流行病学特点及预后的影响因素。方法选取2017年11月至2022年9月本院PICU收治的54例脓毒性休克患者为研究对象,根据患儿预后情况,分为存活组(33例)和死亡组21例。记录并比较两组临床资料、实验室资料差异,二元多因素logistic回归分析儿童脓毒性休克患儿预后的影响因素。结果分离鉴定培养出病原菌33株,其中以革兰氏阳性菌17株(51.52%)、革兰氏阴性菌14株(42.42%)、病毒2株(6.06%),其中多重感染患者4例(含混合感染2例)。两组病原菌分布比较,差异无统计学意义(P>0.05)。54例脓毒性休克患儿发生感染部位分别为中枢神经系统27例(50.00%),呼吸系统20例(37.04%),消化系统4例(7.41%),感染部位未确定2例(3.70%)。两组感染部位分布比较,差异无统计学意义(P>0.05)。与存活组比较,死亡组脏器功能障碍数、血管活性药物使用数量、血乳酸(Lac)水平、急性生理与慢性健康状况评估(APACHEⅡ)评分更高,机械通气时间更短,差异有统计学意义(P<0.05)。logistic回归分析结果显示,脏器功能障碍数、机械通气时间是PICU脓毒性休克患者预后的影响因素(P<0.05)。结论需针对危险因素早期干预脓毒性休克以降低死亡率。

Objective To investigate the epidemiological characteristics and prognostic factors of children with septic shock in children intensive care unit(PICU).Methods Fifty-four patients with septic shock admitted to PICU of our hospital from November 2017 to September 2022 were selected as the study objects.According to the prognosis of the children,they were divided into survival group(33 cases)and death group(21 cases).The clinical and laboratory data of the two groups were recorded and compared.The factors influencing the prognosis of children with septic shock were analyzed by binary logistic regression.Results 33 strains of pathogenic bacteria were isolated,identified and cultured,including 17 Gram-positive bacteria(51.52%),14 Gram-negative bacteria(42.42%)and 2 viruses(6.06%),among which 4 patients with multiple infections(including 2 mixed infections).There was no significant difference in the distribution of pathogens between the two groups(P>0.05).The infection site of 54 children with septic shock was central nervous system in 27 cases(50.00%),respiratory system in 20 cases(37.04%),digestive system in 4 cases(7.41%),and the infection site was not identified in 2 cases(3.70%).There was no significant difference in the distribution of infection sites between the two groups(P>0.05).Compared with the survival group,the number of organ dysfunction,the number of vasoactive drugs used,blood lactate(Lac)level,acute physiological and chronic health assessment(APACHⅱ)scores in the death group were higher,and the mechanical ventilation time was shorter,with statistical significance(P<0.05).logistic regression analysis showed that the number of organ dysfunction and mechanical ventilation time were the prognostic factors of PICU septic shock patients(P<0.05).Conclusion Early intervention of septic shock based on risk factors is needed to reduce mortality.