脓毒性休克患儿死亡危险因素分析

Risk factors for death in children with septic shock

摘要:

目的：探讨脓毒性休克患儿的死亡危险因素，以指导脓毒性休克患儿的治疗，降低死亡率。方法：对53例脓毒性休克患儿10项可能的危险因素先进行单因素分析，然后对单因素分析有显著意义的因素做多因素logistic回归分析。结果：单因素分析和logistic回归分析显示动脉血pH值<7.0、低血压、器官功能障碍数目≥3个、小儿危重病例评分<70分、未在休克后6 h内完成容量复苏、未在休克后1 h内使用有效抗生素、未合理应用血管活性药物为脓毒性休克患儿死亡的危险因素。结论：动脉血pH值<7.0、血压下降、器官功能障碍数目≥3个、小儿危重病例评分<70分的脓毒性休克患儿预后差、死亡率高。若在休克后1 h内能使用有效抗生素、6 h内能完成容量复苏、并能合理应用血管活性药物，则可提高脓毒性休克患儿的治愈率，降低死亡率。［中国当代儿科杂志，2009，11（4）：280-282］

Abstract:

OBJECTIVE: To identify the risk factors for death in children with septic shock. METHODS: Clinical data of 53 children with septic shock admitted to the Yuying Children's Hospital between January 2006 and July 2008 were retrospectively studied. Risk factors for death were assessed using univariate analysis and logistic regression analysis. RESULTS: Nineteen cases died out of 53 children with septic shock. Univariate analysis and logistic regression analysis showed that arterial blood pH value <7.0 (OR=89.66), hypotension (OR=84.00), the pediatric critical illness score<70 (OR=60.00), the number of organ dysfunction ≥3 (OR=38.98), uncompletion of volume resuscitation within 6 hrs after shock (OR=26.41), and no administration of effective antibiotics within 1 hr after shock (OR=11.43) and of vasoactive drugs (OR=75.68) were risk factors for death in children with septic shock. CONCLUSIONS: A low arterial blood pH value (<7.0), hypotension, a pediatric critical illness score (<70) and the number of organ dysfunction ≥3 are related to a high mortality in children with septic shock. If the volume resuscitation can be completed within 6 hrs after shock, effective antibiotics can be administered within 1 hr after shock, and vasoactive drugs can be used properly, the outcome of children with septic shock may be improved.［Chin J Contemp Pediatr, 2009, 11 (4):280-282］