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目的分析以胃肠道感染起病的小儿脓毒性休克及多器官功能障碍综合征衰竭(MODS MOF)的临床特征、病因及转归。方法总结2000年1月至2004年12月收治的28例患儿,在胃肠道感染发病后,发生脓毒性休克及MODS MOF的临床特征、死亡影响因素。结果28例患儿中,21例死亡,病死率为75%。年龄(1.9±3.4)岁,19例(67.8%)小于1岁。累及(3.7±0.9)个器官,发病至出现首个系统或器官功能障碍时间为(39.4±24)h。受累脏器频度依次为循环系统28例(100%)、胃肠道21例(75%)、肺20例(71.4%)、肾14例(50%)、脑9例(32.4%)、血液9例(32.4%)、肝5例(17.9%)。最早出现障碍的器官分别是胃肠道13例(46.4%),循环系统11例(39.3%),肺4例(14.3%)。容量复苏1h内液量30～75ml kg,(46.2±12.6)ml kg;6h内输液量70～120ml kg,(92.7±33.9)ml kg。6h内达到和未达复苏目标(EGDT)者病死率分别为66.7%和90.0%。合并器官衰竭数目和危重评分值与病死关系有显著性(P<0.05或P<0.01)。结论小儿源于胃肠道感染后的MODS MOF,发病年龄小,病情进展迅速,病死率高;容量复苏液体需要量大,6h达到复苏目的者预后较好。
Objective To analyze the clinical characteristics, etiology and prognosis of septic shock and multiple organ dysfunction syndrome (MODS MOF) in children with gastrointestinal tract infection. Methods From January 2000 to December 2004, 28 children were enrolled in this study. The clinical characteristics of septic shock and MODS MOF were observed after the onset of gastrointestinal infection, and the influencing factors of death were recorded. Results Of the 28 children, 21 died and the case fatality rate was 75%. Age (1.9 ± 3.4) years old, 19 cases (67.8%) less than 1 year old. Involved (3.7 ± 0.9) organs, the onset of the first system or organ dysfunction time (39.4 ± 24) h. The frequency of affected organs was circulatory system in 28 cases (100%), gastrointestinal tract in 21 cases (75%), lung in 20 cases (71.4%), kidney in 14 cases (50%) and brain in 9 cases (32.4% Blood 9 cases (32.4%), liver 5 cases (17.9%). The earliest organ dysfunction were gastrointestinal tract in 13 cases (46.4%), circulatory system in 11 cases (39.3%) and lung in 4 cases (14.3%). Volume within 1h volume recovery 30 ~ 75ml kg, (46.2 ± 12.6) ml kg; 6h infusion 70 ~ 120ml kg, (92.7 ± 33.9) ml kg. The mortality rates reached or failed to reach the goal of recovery within 6 hours (EGDT) were 66.7% and 90.0%, respectively. There was a significant relationship between the number of combined organ failure and the score of critical illness and illness (P <0.05 or P <0.01). Conclusion The children with MODS MOF after gastrointestinal tract infection have a small age of onset, rapid progression and high mortality rate. The volume of fluid required for resuscitation is high, and the prognosis is good after 6 hours of resuscitation.