小儿危重病与胃肠功能障碍关系探讨

目的：很多危重病的病程中均可出现胃肠功能障碍。该文通过测定危重患儿TNF α, IL 1β和IL 6的变化及对发生全身炎症反应综合征(SIRS)、多器官衰竭(MOF)和胃肠功能障碍及死亡进行回归分析,探讨小儿危重病与胃肠功能障碍的关系,并进一步阐明炎症反应在胃肠功能障碍及危重病发展中的作用。方法：对该院PICU2000~2003年收治的2 632例患儿的临床和实验室资料进行回顾性分析,SIRS分级与胃肠功能障碍的关系及SIRS、MOF分级、胃肠功能障碍与死亡的关系用logistic回归分析;胃肠功能障碍与MOF的关系用logistic回归分析,胃肠功能障碍与MOF分级的关系用χ2 检验。TNF α, IL 1β和IL 6以 x±s表示,两组均数比较采用t检验。结果：SIRS是胃肠功能障碍的危险因素,符合SIRS诊断指标项目越多,胃肠功能障碍的危险越大(OR值4. 711),有统计学意义(P<0. 05)。胃肠功能障碍是MOF的危险因素,有胃肠功能障碍时,发生MOF的危险性增大(OR值1 450. 070),但无统计学意义(P>0. 05)。存在胃肠功能障碍时,MOF中出现功能障碍的器官数目越多,差异越有显著性意义(χ2 =75.6, P<0.05)。以SIRS,MOF和胃肠功能障碍作为自变量,死亡作为因变量,SIRS,MOF和胃肠功能障碍均是死亡的危险因素(OR值分别为19. 642, 58. 252, 63. 800),有统计学意义（P<0.05）。胃肠功能障碍组TNFα, IL1β和 IL6明显高于无胃肠功能障碍组， TNFα 90.51±3.32 vs 27.48±2.53， IL1β 8.13±2.34 vs 6.03±1.81，IL6 75.86±7.24 vs 10.96±2.24（ng/L）。差异有显著性（P<0.05）。结论：胃肠功能障碍与危重病关系密切，细胞因子参与了胃肠功能障碍的发生。临床应早期诊断胃肠功能障碍，早期干预。 ［中国当代儿科杂志，2005, 7(2): 134-136］

Relationship between gastrointestinal dysfunction and childhood critical illness

OBJECTIVE: Gastrointestinal dysfunction often occurs in the clinical course of many critical illnesses. In order to explore the relationship between gastrointestinal dysfunction and critical illness and to study the role of inflammatory response in the development of gastrointestinal dysfunction and critical illness, this study examined the changes of TNF-α, IL-1β and IL-6 levels in critically ill children and made the regression analysis on systemic inflammatory response syndrome (SIRS), multiple organ failure (MOF), gastrointestinal dysfunction and death. METHODS: The medical data of 2 632 critically ill children admitted to the PICU of The Second Clinical Hospital, China Medical University between 2000 and 2003 were analyzed retrospectively. Logistic regression analysis was used to evaluate the relationship between SIRS classification and gastrointestinal dysfunction as well as the relationship of SIRS classification, MOF classification and gastrointestinal dysfunction with death. The Chi-square test was used to evaluate the relationship between gastrointestinal dysfunction and MOF classification. The levels of TNF-α, IL-1β and IL-6 were expressed as ±s. The Student T- test was used to evaluate the differences between groups. RESULTS: Logistic regression analysis showed that SIRS was a risk factor for gastrointestinal dysfunction (OR=4.711, P<0.05). The prevalence of MOF was not significantly associated with gastrointestinal dysfunction. A significant correlation was found between the number of involved organs in MOF and gastrointestinal dysfunction(χ2=75.6, P<0.05). SIRS classification, MOF classification and gastrointestinal dysfunction were all the risk factors for death(OR =19.642,58.252,63.800 respectively, all P<0.05). The levels of TNF-α, IL-1β and IL-6 in children with gastrointestinal dysfunction were significantly higher than in those without(90.51±3.32 ng/L vs 27.48±2.53 ng/L, 8.13±2.34 ng/L vs 6.03±1.81 ng/L,75.86±7.24 ng/L vs 10.96±2.24 ng/L, respectively, all P<0.05). CONCLUSIONS: Gastrointestinal dysfunction is closely related to critical illness. Cytokines may be involved in the development of gastrointestinal dysfunction. Early diagnosis and active intervention of gastrointestinal dysfunction are needed for children with critical illness.