细菌性血流感染患儿发热程度与预后的关系

Relationship between fever degree and prognosis in children with bacterial bloodstream infection

摘要:

目的 研究细菌性血流感染患儿入院48 h内发热程度与预后的关系。方法 回顾性统计了2008年9月至2016年9月间入住中国医科大学附属盛京医院儿科重症监护病房（PICU）所有诊断为脓毒症的病例资料，筛选出符合细菌性血流感染的病例，根据其入院48 h内最高体温将其分为5组： < 36.5℃组，36.5℃~组（正常对照），37.5℃~组，38.5℃~组和39.5℃~组，比较5组病死率有无差异。结果 符合细菌性血流感染的病例共213例，其中< 36.5℃组5例，36.5℃~组44例，37.5℃~组73例，38.5℃~组69例，39.5℃~组22例。213例患儿中，死亡48例。5组病死率比较差异有统计学意义（P < 0.01），其中< 36.5℃组及39.5℃~组病死率显著高于正常对照组，差异有统计学意义；其他两组（37.5℃~组和38.5℃~组）与正常对照组比较差异无统计学意义。结论 细菌性血流感染患儿入院48 h内最高体温低于36.5℃或高于39.5℃者病死率会明显升高。

Abstract:

Objective To study the relationship between the degree of fever within 48 hours of admission and the prognosis in children with bacterial bloodstream infection. Methods This study retrospectively analyzed the clinical data of all patients diagnosed with sepsis who were admitted to the pediatric intensive care unit (PICU) of Shengjing Hospital Affiliated to China Medical University between September 2008 and September 2016. The children with bacterial bloodstream infection were classified into 5 groups according to the maximum temperature within 48 hours of admission: < 36.5℃ group, ≥36.5℃ group (normal control), ≥37.5℃ group, ≥38.5℃ group, and ≥39.5℃ group. The mortality was compared between the five groups. Results A total of 213 children with bacterial bloodstream infection were enrolled, consisting of 5 cases in the < 36.5℃ group, 44 cases in the ≥36.5℃ group, 73 cases in the ≥37.5℃ group, 69 cases in the ≥38.5℃ group, and 22 cases in the ≥39.5℃ group. A total of 48 cases died among the 213 patients. A significant difference was observed in the mortality between the five groups (P < 0.01). The < 36.5℃ group and ≥39.5℃ group had significantly higher mortality than the normal control group. However, there were no significant differences in the mortality between the ≥37.5℃ and ≥38.5℃ groups and the normal control group. Conclusions In children with bacterial bloodstream infection, those with a maximum temperature below 36.5℃ or above 39.5℃ within 48 hours of admission have a significantly increased mortality.