ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2017, Vol. 9 ›› Issue (3): 236-240.doi: 10.3969/j.issn.1674-3865.2017.03.017

• 临床研究 • 上一篇    下一篇

儿童脓毒症致多器官功能不全综合征的临床分析

闫小红，刘淑霞，刘云，李宗尚   

  1. 461670 河南 禹州，禹州市人民医院儿科
  • 出版日期:2017-06-25 发布日期:2017-12-08
  • 通讯作者: 闫小红，E-mail：13700897781@163.com
  • 作者简介:闫小红（1968-），女，副主任医师。研究方向：儿科感染性疾病的诊治

Clinical analysis of multiple organ dysfunction syndrome caused by sepsis in children

YAN Xiaohong，LIU Shuxia，LIU Yun，LI Zongshang   

  1. Department of Pediatrics，Yuzhou People's Hospital，Yuzhou 461670，China
  • Online:2017-06-25 Published:2017-12-08

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摘要：
目的
了解儿童脓毒症致多器官功能不全综合征(MODS)的临床特点及其对预后的影响。
方法
2011年8月至2016年6月禹州市人民医院PICU病房收治脓毒症患儿204例，分析其累及器官的情况，随访终点事件(90 d死亡或难免死亡)，行趋势χ2检验、多因素Cox比例风险回归和Kaplan-Meier法生存分析。
结果
(1)204例脓毒症患儿共发生MODS者83例，发生率40.69%(95%CI：33.89%～47.48%)；不同年龄患儿的MODS发生率分别是：2 d至1个月68.75%（11/16），＞1个月至1岁55.10%（27/49），＞1～5岁39.62%（21/53），＞5～12岁32.61%（15/46），＞12～17岁22.50%（9/40），随着年龄的增大MODS的发生率逐渐降低（P<0.05）。(2)累及器官的频次依次是肺61例(29.90%)、心52例(25.49%)、血液41例(20.10%)、神经36例(17.65%)、胃肠19例(9.31%)和肾12例(5.88%)。发生2个、3个、≥4个器官功能不全者分别为19例(22.89%)、46例(55.42%)和18例(21.69%)。(3)无MODS、2个、3个和≥4个器官功能不全患儿的90 d生存率分别是87.6%、63.2%、41.3%和11.1%，Log Rank(Mantel-Cox)检验，χ2=92.59，P=0.000。Cox比例风险回归校正了年龄、氧合指数等混杂因素的干扰后，MODS仍然是影响患儿预后的显著因素，MODS的HR=2.573，6.579，12.699，P<0.05。
结论
低龄儿童是脓毒症并发MODS的高危人群，最易受累的靶器官是肺脏、心脏和血液。MODS独立影响患儿90 d生存率，早期监测和预防MODS，切断MODS恶性循环，可望改善患儿预后。

关键词: 脓毒症, 多器官功能不全, 预后, 儿童

Abstract:
Objective
To understand the clinical characteristics and prognosis of multiple organ dysfunction syndrome(MODS) caused by sepsis in children.
Methods
This study included 204 children with sepsis hospitalized to PICU in Yuzhou People's Hospital from August 2011 to June 2016，and their involved organs were analyzed; the end-point events(90d death or inevitable death) were followed up.Trend Chi-square test，multiple Cox proportional hazards regression and survival analysis (Kaplan-Meier methods) were performed.
Results
(1)The incidence of MODS was 83 cases［40.69%(95%CI：33.89%-47.48%)］ in 204 children with sepsis. The incidence rate of MODS was 68.75%（11/16），55.10%（27/49），39.62%（21/53），32.61%（15/46） and 22.50%（9/40） for the children at the age of 2 d to 1 month，＞1 month to 1 year，＞1 to 5 years，＞5 to 12 years and ＞12 to 17 years，with significant differences among children at different ages（P<0.05）.(2)The frequency order of involved organs were lung(61 cases，29.90%)，heart(52 cases，25.49%)，blood system(41 cases，20.10%)，nervous system(36 cases，17.65%)，gastrointestinal tract(19 cases，9.31%) and kidney(12 cases，5.88%).The incidence of dysfunction in 2，3 and ≥4 organs was 19 cases(22.89%)，46 cases(55.42%) and 18 cases(21.69%)，respectively.(3)The 90d survival rate of the children with non-MODS，2-，3- and ≥4- organ dysfunction were 87.6%，63.2%，41.3% and 11.1%，respectively，χ2=92.59，P=0.000.After adjusting for age，oxygenation index，etc，multiple Cox proportional hazards regression showed that MODS was an independent factor of prognosis，HR=2.573，6.579，12.699，P＜0.05.
Conclusion
Young children are the high-risk population of MODS caused by sepsis. The main dysfunctional organs were lung，heart and blood system. MODS are the independent factors influencing the 90d survival rate of children with sepsis. Early detection，prevention and cutting off the transmission vicious circle of MODS are important to improve the outcome of child patients.

Key words: Sepsis, Multiple organ dysfunction, Prognosis, Children