儿科重症监护病房脓毒血症临床及病原学分析

目的:探讨儿科重症监护室(PICU)脓毒血症血培养病原菌的分布特点及其耐药情况,为临床诊疗提供参考。方法:对苏州大学附属儿童医院2008年6月至2011年6月PICU送检的脓毒血症血液标本所分离病原菌的分布及药敏结果进行回顾性分析。结果:共检出45株病原菌,其中革兰阳性(G+)菌29株(64.4%)、革兰阴性菌(G-)15株(33.3%)、真菌1株(2.2%)。前3位的病原菌依次为表皮葡萄球菌(22.2%)、肺炎链球菌(17.8%)、铜绿假单胞菌(17.8%)。G+球菌对儿科常用的β-内酰胺类药物多数耐药,而对万古霉素、复方磺胺甲唑敏感性较高;G-杆菌对第三代头孢菌素高度耐药,而对亚胺培南、环丙沙星、左氧氟沙星敏感性较高。结论:表皮葡萄球菌、肺炎链球菌、铜绿假单胞菌等条件致病菌已成为PICU脓毒血症的主要致病菌,且对常用的多数β-内酰胺类药物耐药。铜绿假单胞菌所致脓毒血症病死率较高,且对多数药物耐药明显。前期经验性抗生素治疗,后期根据药敏结果合理应用抗菌药物是有效控制感染、降低病死率、改善预后的重要手段。     

儿科监护室优质护理指征：患儿家长与护理人员观点调查

目的调查儿科监护室患儿家长与护理人员对优质护理指征的认知,为优质护理提供依据。方法自行设计优质护理认知调查问卷,对儿科监护室护士及患儿家长进行调查。结果护士与患儿家长对优质护理的认知存在差并,二者既有共同观点,又有各自独特见解。结论护士对患儿家长优质护理指征的准确把握是提供优质护理提高家长满意度的前提。     

Hypophosphatemia and its clinical implications in critically ill children: A retrospective study

Purpose

The aims of this study were to determine the prevalence of hypophosphatemia and to discuss the clinical implications of hypophosphatemia in critically ill children.

Materials and Methods

A retrospective review of the medical records of children admitted to the pediatric intensive care unit from December 2006 to December 2007 was conducted.

Results

In 60.2% (n = 71) of the patients, any serum phosphorous level at admission and at the third day or seventh day after admission to pediatric intensive care unit was in hypophosphatemic range. Sepsis was present in 22.9% (n = 27) of the children studied and was associated with hypophosphatemia (P = .02). Hypophosphatemia was also associated with use of furosemide (P = .04), use of steroid (P = .04), use of β₂ agonist (P = .026), and use of an H₂ blocker (P = .004). There was a significant association between hypophosphatemia and the rate to attain target caloric requirements by enteral route (P = .007). The median time to attain target caloric requirements by enteral route was 2.9 ± 1.9 (0.2-10) days in the normophosphatemic group and 4.4 ± 2.8 (0.3-12) days in the hypophosphatemic group. In the multiple regression model, solely the rate to attain the target caloric requirements by enteral route demonstrated independent association with hypophosphatemia (P = .006; β = .27; 95% confidence interval, 0.02-0.09). Significant association was found between hypophosphatemia and the duration of mechanical ventilation and between hypophosphatemia and pediatric intensive care unit length of stay (P = .02 and P = .001, respectively).

Conclusions

Critically ill pediatric patients are prone to hypophosphatemia, especially if they cannot be fed early by enteral route. Hypophosphatemia is associated with an increased duration of mechanical ventilation and increased length of stay in the pediatric intensive care unit, suggesting that active repletion might improve these parameters.     

中心静脉压监测在PICU危重症患儿中的应用及护理

目的：通过对危重症患儿进行动态CVP监测,以了解有效循环血量、科学可靠地指导输液及脱水降颅压治疗。方法：行中心静脉导管置,接压力换能器,即可监测中心静脉压。结果：32例患儿目前顺利应用,无并发症。结论：CVP动态监测为临床提供可行的数据,从而有效地提高危重病患儿的抢救成功率。     

Sophia Observation withdrawal Symptoms-Paediatric Delirium scale: A tool for early screening of delirium in the PICU

Background

Delirium in critically ill children is a severe neuropsychiatric disorder which has gained increased attention from clinicians. Early identification of delirium is essential for successful management. The Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) scale was developed to detect Paediatric Delirium (PD) at an early stage.