兒童膿毒性休克的臨床特點(diǎn)及死亡危險因素分析
發(fā)布時間：2019-01-23 15:31
【摘要】：目的：總結(jié)膿毒性休克的臨床特征,探討膿毒性休克死亡危險因素,以利于臨床上對該病的早期認(rèn)識、提高膿毒性休克搶救成功率。 方法：對2006年3月-2011年11月廣西醫(yī)科大學(xué)第一附屬醫(yī)院兒科重癥監(jiān)護(hù)病房(PICU)的83例確診膿毒性休克住院患兒進(jìn)行回顧性分析,研究因素包括年齡、性別、臨床表現(xiàn)、血白細(xì)胞計數(shù)(WBC)、血紅蛋白(HGB)濃度、血小板(PLT)計數(shù)、血清總蛋白濃度(TP)、血清白蛋白濃度(ALB)、動脈血?dú)夥治?C-反應(yīng)蛋白(CRP)、血沉(ESR)、血糖、細(xì)菌內(nèi)毒素、真菌葡聚糖、病原學(xué)檢查、感染部位、原發(fā)病、功能障礙臟器數(shù)目、是否需機(jī)械通氣、液體復(fù)蘇時間等,統(tǒng)計學(xué)分析：1)總結(jié)膿毒性休克的臨床特點(diǎn)2)探討膿毒性休克死亡危險因素。 結(jié)果：1.本組資料中膿毒性休克總病死率32.5%,其中合并多臟器功能障礙(MODS)的發(fā)生率為74.5%,死亡率高達(dá)59.09%；臟器損害中肺是最常受累器官。2.本組膿毒性休克患兒死亡組的低血壓發(fā)生率較非死亡組高,差別有統(tǒng)計學(xué)意義(P0.05)。3.本組膿毒性休克多發(fā)生于原發(fā)病治療中,原發(fā)病以血液系統(tǒng)疾病、肺炎及消化器官先天發(fā)育異常最多見,其中血液系統(tǒng)疾病占40.96%,居膿毒性休克死亡原發(fā)病首位。4.本研究中死亡組膿毒性休克患兒液體復(fù)蘇時間較非死亡組長,休克持續(xù)時間長。5.死亡組膿毒性休克患兒較非死亡組病原菌培養(yǎng)陽性率高(P0.05)。6.單因素分析結(jié)果表明,藥物復(fù)蘇時間長、動脈血?dú)馑釅A度(PH)7.35、合并多器官功能受損、病原菌培養(yǎng)陽性4個影響因素是膿毒性休克的死亡危險因素。年齡、性別、住院時間、低血壓、白細(xì)胞及中性粒細(xì)胞計數(shù)、HGB、血小板計數(shù)、C-反應(yīng)蛋白、血漿白蛋白濃度、剩余堿(BE)、ESR、血糖、細(xì)菌內(nèi)毒素、真菌葡聚糖、機(jī)械通氣與膿毒性休克死亡關(guān)聯(lián)無統(tǒng)計學(xué)意義。但多因素Logistic回歸分析顯示藥物復(fù)蘇時間長、動脈血?dú)釶H7.35、合并多器官功能受損、病原體培養(yǎng)陽性4個影響因素與死亡的關(guān)聯(lián)均無統(tǒng)計學(xué)意義(P0.05)。 結(jié)論：1.兒童膿毒性休克死亡率高,早期識別和積極液體復(fù)蘇有利于降低其死亡率。2.單因素分析復(fù)蘇時間長、動脈血?dú)釶H7.35、合并多器官功能障礙、病原菌培養(yǎng)陽性是膿毒性休克的死亡危險因素。3.加強(qiáng)預(yù)防院內(nèi)感染也是降低膿毒性休克發(fā)生率及死亡風(fēng)險的關(guān)鍵。4.早期識別的線索：原發(fā)病、微循環(huán)功能障礙指導(dǎo)意義更大。
[Abstract]:Objective: to summarize the clinical features of septic shock and to explore the risk factors of septic shock, so as to promote the early understanding of septic shock and improve the success rate of rescuing septic shock. Methods: 83 hospitalized children with septic shock in pediatric intensive care unit (PICU) of the first affiliated Hospital of Guangxi Medical University from March 2006 to November 2011 were analyzed retrospectively. The factors included age, sex and clinical manifestation. White blood cell count (WBC), hemoglobin (HGB) concentration, platelet (PLT) count, serum total protein concentration (TP), serum albumin concentration (ALB), arterial blood gas analysis, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), blood glucose, Bacterial endotoxin, fungal dextran, etiology, site of infection, primary disease, number of organs with dysfunction, need mechanical ventilation, time of fluid resuscitation, etc. Statistical analysis: 1) summarize the clinical features of septic shock 2) explore the death risk factors of septic shock. Results: 1. The mortality rate of septic shock was 32.5%, of which the incidence of multiple organ dysfunction (MODS) was 74.55.The mortality rate was 59.09.The lung was the most frequently involved organ in organ damage. 2. The incidence of hypotension in the death group of septic shock patients was higher than that in the non-death group (P0.05). Most of the septic shock occurred in the treatment of primary diseases. Hematological diseases, pneumonia and abnormal congenital development of digestive organs were the most common diseases, of which hematological diseases accounted for 40.96, leading to death from septic shock. In this study, the fluid resuscitation time of septic shock children in death group was longer than that of non-death group, and the duration of shock was 5. 5%. The positive rate of bacterial culture in septic shock group was higher than that in non-dead group (P0.05). Univariate analysis showed that the death risk factors of septic shock were long time of drug resuscitation, (PH) 7.35 of arterial blood gas pH, damage of multiple organ function and positive culture of pathogenic bacteria. Age, sex, length of stay, hypotension, leukocyte and neutrophil count, HGB, platelet count, C-reactive protein, plasma albumin concentration, residual alkali (BE), ESR, glucose, bacterial endotoxin, fungal dextran, There was no significant correlation between mechanical ventilation and septic shock death. But multivariate Logistic regression analysis showed that drug resuscitation time was long, arterial blood gas PH7.35, combined with multiple organ function damage, pathogen culture positive four factors were not significantly related to death (P0.05). Conclusion: 1. The mortality rate of septic shock in children is high, and early identification and active fluid resuscitation can reduce the mortality rate. 2. 5%. Univariate analysis showed that the mortality risk factors of septic shock were long resuscitation time, arterial blood gas PH7.35, combined with multiple organ dysfunction, positive culture of pathogenic bacteria. Strengthening the prevention of nosocomial infection is also the key to reduce the incidence of septic shock and the risk of death. 4. Clues for early identification: primary disease, microcirculation dysfunction is more instructive.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R720.597
本文編號：2413945
[Abstract]:Objective: to summarize the clinical features of septic shock and to explore the risk factors of septic shock, so as to promote the early understanding of septic shock and improve the success rate of rescuing septic shock. Methods: 83 hospitalized children with septic shock in pediatric intensive care unit (PICU) of the first affiliated Hospital of Guangxi Medical University from March 2006 to November 2011 were analyzed retrospectively. The factors included age, sex and clinical manifestation. White blood cell count (WBC), hemoglobin (HGB) concentration, platelet (PLT) count, serum total protein concentration (TP), serum albumin concentration (ALB), arterial blood gas analysis, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), blood glucose, Bacterial endotoxin, fungal dextran, etiology, site of infection, primary disease, number of organs with dysfunction, need mechanical ventilation, time of fluid resuscitation, etc. Statistical analysis: 1) summarize the clinical features of septic shock 2) explore the death risk factors of septic shock. Results: 1. The mortality rate of septic shock was 32.5%, of which the incidence of multiple organ dysfunction (MODS) was 74.55.The mortality rate was 59.09.The lung was the most frequently involved organ in organ damage. 2. The incidence of hypotension in the death group of septic shock patients was higher than that in the non-death group (P0.05). Most of the septic shock occurred in the treatment of primary diseases. Hematological diseases, pneumonia and abnormal congenital development of digestive organs were the most common diseases, of which hematological diseases accounted for 40.96, leading to death from septic shock. In this study, the fluid resuscitation time of septic shock children in death group was longer than that of non-death group, and the duration of shock was 5. 5%. The positive rate of bacterial culture in septic shock group was higher than that in non-dead group (P0.05). Univariate analysis showed that the death risk factors of septic shock were long time of drug resuscitation, (PH) 7.35 of arterial blood gas pH, damage of multiple organ function and positive culture of pathogenic bacteria. Age, sex, length of stay, hypotension, leukocyte and neutrophil count, HGB, platelet count, C-reactive protein, plasma albumin concentration, residual alkali (BE), ESR, glucose, bacterial endotoxin, fungal dextran, There was no significant correlation between mechanical ventilation and septic shock death. But multivariate Logistic regression analysis showed that drug resuscitation time was long, arterial blood gas PH7.35, combined with multiple organ function damage, pathogen culture positive four factors were not significantly related to death (P0.05). Conclusion: 1. The mortality rate of septic shock in children is high, and early identification and active fluid resuscitation can reduce the mortality rate. 2. 5%. Univariate analysis showed that the mortality risk factors of septic shock were long resuscitation time, arterial blood gas PH7.35, combined with multiple organ dysfunction, positive culture of pathogenic bacteria. Strengthening the prevention of nosocomial infection is also the key to reduce the incidence of septic shock and the risk of death. 4. Clues for early identification: primary disease, microcirculation dysfunction is more instructive.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R720.597
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 趙毅斌;唐國軍;肖曙芳;;膿毒性休克患兒液體復(fù)蘇臨床意義探討[J];中國醫(yī)療前沿;2009年21期
，本文編號：2413945
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