本文關(guān)鍵詞： 兒童 血液腫瘤 膿毒性休克 危險因素　出處：《中國實用兒科雜志》2017年05期 　論文類型：期刊論文

【摘要】：目的探討兒童重癥監(jiān)護(hù)病房(PICU)惡性血液腫瘤合并膿毒性休克患兒的臨床特點及其死亡危險因素。方法對中山大學(xué)孫逸仙紀(jì)念醫(yī)院PICU 2012年3月至2015年9月收治的43例惡性血液腫瘤合并膿毒性休克患兒的臨床資料進(jìn)行回顧性分析。結(jié)果43例休克患兒中,存活27例,死亡16例,病死率37.2%。最常見感染部位為肺部(74.4%),其次為胃腸道(39.5%)。病原學(xué)檢查陽性者26例,共分離出病原菌43株,其中G+菌5株(11.6%),G-菌31株(72.1%),真菌7株(16.3%),以大腸埃希菌占首位(6/43,14.0%)。存活組與死亡組比較,患兒在年齡、化療階段、感染至休克累計時間、粒細(xì)胞缺乏至休克累計時間、多器官功能障礙(MODS)受累器官數(shù)、肺部受累、低鈣血癥、液體復(fù)蘇后6 h的氧合指數(shù)及乳酸水平、多巴胺使用劑量以及是否需要機(jī)械通氣方面,差異均具有統(tǒng)計學(xué)意義(P均0.05)。多因素Logistic回歸分析結(jié)果顯示:與膿毒性休克患兒死亡相關(guān)的變量為液體復(fù)蘇后6 h的乳酸水平及機(jī)械通氣的應(yīng)用。結(jié)論惡性血液腫瘤合并膿毒性休克經(jīng)液體復(fù)蘇后6 h仍存在高乳酸中毒、合并低鈣血癥以及需要機(jī)械通氣的患兒病死率高,應(yīng)更為重視。
[Abstract]:Objective to investigate the clinical characteristics and risk factors of death in children with malignant hematoma complicated with septic shock in children's intensive care unit (ICU). Methods 43 patients admitted to Sun Yat-Sen Memorial Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University from March 2012 to September 2015 were enrolled in this study. The clinical data of 43 children with malignant hematologic tumor complicated with septic shock were retrospectively analyzed. 27 cases survived, 16 cases died, and the mortality was 37.2%. The most common site of infection was lung 74.4%, followed by gastrointestinal tract 39.55.The pathogen was positive in 26 cases, and 43 strains of pathogenic bacteria were isolated. Among them, there were 5 strains of G bacteria, 31 strains of G- bacteria, 72.1% of them, 7 strains of fungi, 7 strains of fungi, among which Escherichia coli accounted for the first 6 / 43% and 14.0%. Compared with the dead group, the age, chemotherapy stage, cumulative time of infection to shock, the time of granulocytosis to shock, the time of granulocytosis to shock in the survival group were higher than those in the dead group. The number of involved organs, lung involvement, hypocalcemia, oxygenation index and lactate level at 6 hours after fluid resuscitation, dopamine dosage, and whether mechanical ventilation is required. The results of multivariate Logistic regression analysis showed that the variables associated with death in septic shock were the level of lactic acid 6 hours after fluid resuscitation and the application of mechanical ventilation. Conclusion\\\; Hyperlactic acid poisoning still existed 6 hours after fluid resuscitation in the tumor complicated with septic shock. More attention should be paid to the mortality of children with hypocalcemia and need of mechanical ventilation.
【作者單位】： 中山大學(xué)孫逸仙紀(jì)念醫(yī)院PICU;
【分類號】：R720.597;R733

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