基础疾病对脓毒性休克患儿临床特征和预后的影响

目的:了解儿童重症监护病房(pediatric intensive care unit，PICU)内不同基础性疾病并发脓毒性休克(septic shock，SS)患儿的临床特征和预后。方法:回顾性收集2017年1月1日至2019年12月31日北京儿童医院PICU收治的SS患儿病历资料，按照有无基础疾病、基础疾病种类进行...

Effects of basic diseases on clinical characteristics and prognosis of septic shock in children

Objective To investigate the clinical features and prognosis of septic shock(SS)children with different basic diseases in pediatric intensive care unit(PICU).Methods The medical records of SS children admitted to PICU at Beijing Children′s Hospital from January 1,2017 to December 31,2019 were collected retrospectively.They were grouped according to the presence or absence of basic diseases and types of basic diseases.The clinical characteristics,prognosis and pathogens of SS under different basic diseases were summarized.Results A total of 218 children with SS were included during the study period,and the overall case fatality rate was 21.6%(47/218).There were 141 cases with basic diseases,accounting for 64.7%(141/218)and 24.1%(34/141)case fatality rate.The mortality rate was highest(37.5%,17/45)in the malignant hematologic diseases and tumors patients with post-chemotherapy bone marrow suppression,and lowest(16.9%,13/77)in patients with no underlying diseases.Gram-negative bacterial infection was more common in SS children with underlying diseases(63.1%,41/65),and was highest in the malignant hematologic diseases and tumors patients with post-chemotherapy bone marrow suppression(80.0%,20/25).Gram-positive bacteria accounted for the highest proportion in the group without underlying disease(52.1%,25/48).The incidence of multiple organ dysfunction syndrome(MODS)was the highest(95.6%,43/45)in the malignant hematologic diseases and tumors patients with post-chemotherapy bone marrow suppression,and the lowest(59.7%,46/77)in the group without underlying disease.Conclusion Gram-negative bacteria is the most common pathogen in SS children with underlying diseases,especially in malignant hematologic diseases and tumors patients with post-chemotherapy bone marrow suppression,and with high mortality and incidence of MODS.Gram-positive bacteria is the most common pathogen for those without underlying diseases,with a relatively low mortality and incidence of MODS.