儿童脓毒症新发功能障碍的特点
|
摘要
目的探讨儿科重症监护病房脓毒症患儿新发功能障碍的特点。方法回顾性分析2015～2016年入住儿科重症监护病房的脓毒症患儿的临床资料。比较重度脓毒症(34例)与非重度脓毒症(69例)患儿新发功能障碍发生率和入院、出院功能状态及其变化。结果重度脓毒症组新发功能障碍发生率显著高于非重度脓毒症组(38%vs 6%,P<0.05)。非重度脓毒症组入院功能状态相对良好,出院总体功能状态较入院时改善。重度脓毒症组入院功能状态较差,出院时神志、感觉、沟通、呼吸功能状态处于轻、中度异常状态。结论非重度脓毒症患儿新发功能障碍率低,预后较好。重度脓毒症患儿新发功能障碍发生率高,预后较差。[中国当代儿科杂志,2019,21(6):517-521]
Objective To study the features of new-onset organ dysfunction in children with sepsis in the pediatric intensive care unit(PICU). Methods A retrospective analysis was performed for the clinical data of children with sepsis who were admitted to the PICU from 2015 to 2016. There were 34 children with severe sepsis and 69 with non-severe sepsis, and the two groups were compared in terms of the incidence rate of new-onset organ dysfunction and the functional status on admission and at discharge. Results The severe sepsis group had a significantly higher incidence rate of new-onset organ dysfunction than the non-severe sepsis group(38% vs 6%; P<0.05). The children in the non-severe sepsis group had a relatively good functional status on admission, with marked improvement in the overall functional status at discharge. The children in the severe sepsis group had a poor functional status on admission, with mild/moderate abnormalities in consciousness, sensation, communication and respiratory function at discharge. Conclusions Children with non-severe sepsis have a low incidence rate of new-onset organ dysfunction and a good prognosis, and those with severe sepsis often have a high incidence rate of new-onset organ dysfunction and a poor prognosis. [Chin J Contemp Pediatr, 2019, 21(6): 517-521]
Objective To study the features of new-onset organ dysfunction in children with sepsis in the pediatric intensive care unit(PICU). Methods A retrospective analysis was performed for the clinical data of children with sepsis who were admitted to the PICU from 2015 to 2016. There were 34 children with severe sepsis and 69 with non-severe sepsis, and the two groups were compared in terms of the incidence rate of new-onset organ dysfunction and the functional status on admission and at discharge. Results The severe sepsis group had a significantly higher incidence rate of new-onset organ dysfunction than the non-severe sepsis group(38% vs 6%; P<0.05). The children in the non-severe sepsis group had a relatively good functional status on admission, with marked improvement in the overall functional status at discharge. The children in the severe sepsis group had a poor functional status on admission, with mild/moderate abnormalities in consciousness, sensation, communication and respiratory function at discharge. Conclusions Children with non-severe sepsis have a low incidence rate of new-onset organ dysfunction and a good prognosis, and those with severe sepsis often have a high incidence rate of new-onset organ dysfunction and a poor prognosis. [Chin J Contemp Pediatr, 2019, 21(6): 517-521]
引文
[1]Pollack MM,Holubkov R,Funai T,et al.Pediatric intensive care outcomes:development of new morbidities during pediatric critical care[J].Pediatr Crit Care Med,2014,15(9):821-827.
[2]Singer M,Deutschman CS,Seymour CW,et al.The Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
[3]Yende S,Austin S,Rhodes A,et al.Long-term quality of life among survivors of severe sepsis:analyses of two international trials[J].Crit Care Med,2016,44(8):1461-1467.
[4]Weiss SL,Fitzgerald JC,Pappachan J,et al.Global epidemiology of pediatric severe sepsis:the sepsis prevalence,outcomes,and therapies study[J].Am J Respir Crit Care Med,2015,191(10):1147-1157.
[5]Goldstein B,Giroir B,Randolph A,et al.International pediatric sepsis consensus conference:definitions for sepsis and organ dysfunction in pediatrics[J].Pediatr Crit Care Med,2005,6(1):2-8.
[6]杨雨航,裴亮,杨妮,等.儿科重症监护病房中的新发功能障碍[J].中华儿科杂志,2017,55(6):451-456.
[7]Shankar-Hari M,Phillips GS,Levy ML,et al.Developing a new definition and assessing new clinical criteria for septic shock:for the Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315(8):775-787.
[8]Zhou J,Qian C,Zhao M,et al.Epidemiology and outcome of severe sepsis and septic shock in intensive care units in mainland China[J].PLoS One,2014,9(9):e107181.
[9]Delano MJ,Ward PA.Sepsis-induced immune dysfunction:can immune therapies reduce mortality?[J].J Clin Invest,2016,126(1):23-31.
[10]Needham DM,Davidson J,Cohen H,et al.Improving long-term outcomes after discharge from intensive care unit:report from a stakeholders'conference[J].Crit Care Med,2012,40(2):502-509.
[11]Kramer CL.Intensive care unit-acquired weakness[J].Neurol Clin,2017,35(4):723-736.
[12]Horn J,Hermans G.Intensive care unit-acquired weakness[J].Handb Clin Neurol,2017,141:531-543.
[13]杨雨航,裴亮,杨妮,等.儿科重症监护中新发功能障碍的高危因素分析[J].中华实用儿科临床杂志,2017,32(18):1393-1397.
[14]Field-Ridley A,Dharmar M,Steinhorn D,et al.ICU-acquired weakness is associated with differences in clinical outcomes in critically ill children[J].Pediatr Crit Care Med,2016,17(1):53-57.
[15]Dres M,Goligher EC,Heunks LMA,et al.Critical illnessassociated diaphragm weakness[J].Intensive Care Med,2017,43(10):1441-1452.
[16]Iwashyna TJ,Cooke CR,Wunsch H,et al.Population burden of long-term survivorship after severe sepsis in older Americans[J].J Am Geriatr Soc,2012,60(6):1070-1077.
[17]A n d e r s o n S T,C o m m i n s S,M o y n a g h P N,e t a l.Lipopolysaccharide-induced sepsis induces long-lasting affective changes in the mouse[J].Brain Behav Immun,2015,43:98-109.
[18]Annane D,Sharshar T.Cognitive decline after sepsis[J].Lancet Respir Med,2015,3(1):61-69.
[19]Tauber SC,Eiffert H,Brück W,et al.Septic encephalopathy and septic encephalitis[J].Expert Rev Anti Infect Ther,2017,15(2):121-132.
[20]Als LC,Tennant A,Nadel S,et al.Persistence of neuropsychological deficits following pediatric critical illness[J].Crit Care Med,2015,43(8):e312-e315.
[2]Singer M,Deutschman CS,Seymour CW,et al.The Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
[3]Yende S,Austin S,Rhodes A,et al.Long-term quality of life among survivors of severe sepsis:analyses of two international trials[J].Crit Care Med,2016,44(8):1461-1467.
[4]Weiss SL,Fitzgerald JC,Pappachan J,et al.Global epidemiology of pediatric severe sepsis:the sepsis prevalence,outcomes,and therapies study[J].Am J Respir Crit Care Med,2015,191(10):1147-1157.
[5]Goldstein B,Giroir B,Randolph A,et al.International pediatric sepsis consensus conference:definitions for sepsis and organ dysfunction in pediatrics[J].Pediatr Crit Care Med,2005,6(1):2-8.
[6]杨雨航,裴亮,杨妮,等.儿科重症监护病房中的新发功能障碍[J].中华儿科杂志,2017,55(6):451-456.
[7]Shankar-Hari M,Phillips GS,Levy ML,et al.Developing a new definition and assessing new clinical criteria for septic shock:for the Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315(8):775-787.
[8]Zhou J,Qian C,Zhao M,et al.Epidemiology and outcome of severe sepsis and septic shock in intensive care units in mainland China[J].PLoS One,2014,9(9):e107181.
[9]Delano MJ,Ward PA.Sepsis-induced immune dysfunction:can immune therapies reduce mortality?[J].J Clin Invest,2016,126(1):23-31.
[10]Needham DM,Davidson J,Cohen H,et al.Improving long-term outcomes after discharge from intensive care unit:report from a stakeholders'conference[J].Crit Care Med,2012,40(2):502-509.
[11]Kramer CL.Intensive care unit-acquired weakness[J].Neurol Clin,2017,35(4):723-736.
[12]Horn J,Hermans G.Intensive care unit-acquired weakness[J].Handb Clin Neurol,2017,141:531-543.
[13]杨雨航,裴亮,杨妮,等.儿科重症监护中新发功能障碍的高危因素分析[J].中华实用儿科临床杂志,2017,32(18):1393-1397.
[14]Field-Ridley A,Dharmar M,Steinhorn D,et al.ICU-acquired weakness is associated with differences in clinical outcomes in critically ill children[J].Pediatr Crit Care Med,2016,17(1):53-57.
[15]Dres M,Goligher EC,Heunks LMA,et al.Critical illnessassociated diaphragm weakness[J].Intensive Care Med,2017,43(10):1441-1452.
[16]Iwashyna TJ,Cooke CR,Wunsch H,et al.Population burden of long-term survivorship after severe sepsis in older Americans[J].J Am Geriatr Soc,2012,60(6):1070-1077.
[17]A n d e r s o n S T,C o m m i n s S,M o y n a g h P N,e t a l.Lipopolysaccharide-induced sepsis induces long-lasting affective changes in the mouse[J].Brain Behav Immun,2015,43:98-109.
[18]Annane D,Sharshar T.Cognitive decline after sepsis[J].Lancet Respir Med,2015,3(1):61-69.
[19]Tauber SC,Eiffert H,Brück W,et al.Septic encephalopathy and septic encephalitis[J].Expert Rev Anti Infect Ther,2017,15(2):121-132.
[20]Als LC,Tennant A,Nadel S,et al.Persistence of neuropsychological deficits following pediatric critical illness[J].Crit Care Med,2015,43(8):e312-e315.