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目的探讨儿童脓毒症患者发生多器官功能障碍综合征(MODS)的危险因素。方法收集2007年1-12月首都儿科研究所PICU病房的153例脓毒症患儿,按照是否发生MODS,将患儿分为MODS组(n=28)和非MODS组(n=125)。观察2组患儿年龄、性别、PICU住院时间、慢性病史,确诊脓毒症24h内体温、呼吸、心率、收缩压、WBC计数、血细胞比容、PLT计数、血糖、血钠、血钾、肌酐、肝酶、总胆红素、LDH、动脉血气、CRP、降钙素原(PCT)、凝血功能、脓毒症的原发感染部位、细菌培养情况、确诊前后手术情况、小儿危重病例评分(PCIS)、改良Glasgow昏迷评分、呼吸机治疗率及预后。应用SPSS17.0软件对以上指标进行单因素分析和Logistic回归多因素分析。结果PICU脓毒症发病率为33.3%,病死率为8.5%。PICU中MODS发病率为18.3%,病死率为39.3%。2个、3个及3个以上脏器受累MODS患儿病死率分别为11.1%、41.7%和71.4%。呼吸道感染是脓毒症最常见的原发感染灶(73.2%),中枢神经系统感染患儿病死率最高(8.30%)。细菌是儿童脓毒症最主要病原,以葡萄球菌感染最多见。单因素分析显示,慢性病史、心率、WBC计数、PLT计数、PCT、血糖、血钠、血肌酐、尿素氮、肝酶、LDH、清蛋白、血气、D-二聚体、Glasgow评分、PCIS、机械通气时间,MODS组与非MODS组间比较差异均具有统计学意义;多因素Logistic回归分析显示PCIS评分、ALT及机械通气时间对发生MODS有显著影响。结论PCIS、ALT、机械通气时间可作为脓毒症患儿发生MODS的独立危险因素。
Objective To investigate the risk factors of multiple organ dysfunction syndrome (MODS) in children with sepsis. Methods A total of 153 sepsis patients from PICU ward of Capital Institute of Pediatrics from January 2007 to December 2007 were divided into MODS group (n = 28) and non-MODS group (n = 125) according to whether MODS occurred or not. The changes of body temperature, respiration, heart rate, systolic blood pressure, WBC count, hematocrit, PLT count, blood glucose, serum sodium, serum potassium, creatinine , Liver enzymes, total bilirubin, LDH, arterial blood gas, CRP, procalcitonin (PCT), coagulation function, the primary infection site of sepsis, bacterial culture, diagnosis before and after surgery, pediatric critical cases score PCIS), modified Glasgow coma score, ventilator treatment rate, and prognosis. SPSS17.0 software application univariate analysis of the above indicators and Logistic regression multivariate analysis. Results The incidence of PICU sepsis was 33.3% and the case fatality rate was 8.5%. The incidence of MODS in PICU was 18.3% and the case fatality rate was 39.3%. The morbidity rates of MODS in 2, 3 and more than 3 organs were 11.1%, 41.7% and 71.4% respectively. Respiratory tract infection is the most common primary infection in sepsis (73.2%), and children with CNS infection have the highest case fatality rate (8.30%). Bacteria is the most important pathogen of sepsis in children, with staphylococcal infection the most common. Univariate analysis showed that chronic history, heart rate, WBC count, PLT count, PCT, blood glucose, serum sodium, serum creatinine, urea nitrogen, liver enzymes, LDH, albumin, blood gas, D-dimer, Glasgow score, PCIS, Mechanical ventilation time, the difference between MODS group and non-MODS group were statistically significant; multivariate logistic regression analysis showed that PCIS score, ALT and mechanical ventilation time had a significant effect on the occurrence of MODS. Conclusion PCIS, ALT, mechanical ventilation time can be used as an independent risk factor for MODS in children with sepsis.