侵袭性肺炎链球菌性疾病所致脓毒性休克患儿临床特点及预后分析

目的:了解儿童重症监护病房(PICU)内侵袭性肺炎链球菌性疾病(IPD)所致脓毒性休克患儿的临床特点及预后。方法:回顾性收集2013年1月至2019年8月首都医科大学附属北京儿童医院重症医学科及河南省儿童医院重症医学科收治的IPD所致脓毒性休克患儿的病历资料,分析其临床及预后特点。结果:共纳入患儿21例,年龄1.2(0.75,3.90)岁。入PICU时第二代小儿死亡指数(PIM-2)为(23.3±29.6)%,并基础疾病6例。感染部位主要为血液(20例)及颅内(15例)。18例患儿行药敏试验,其中对青霉素敏感9例,对头孢吡肟/头孢噻肟敏感分别为10例和11例,对美罗培南敏感10例,对万古霉素及利奈唑胺均敏感;病初及脓毒性休克前应用敏感抗生素者分别为7和13例。21例患儿乳酸水平为(6.1±4.6)mmol/L,其中10例经治疗休克纠正时间为(10.9±10.1)h。13/21例(61.9%)患儿休克后死亡时间为(14.6±12.2)h,10例死于枕骨大孔疝。死亡组患儿入PICU时PIM2(37.1±30.3)%比(0.9±1.3)%]及并颅高压危象率69.9%(9/13例)比25%(2/8例)]显著高于存活组,差异均有统计学意义(均P<0.05);但年龄、休克前有效抗生素使用率等差异均无统计学意义(均P>0.05)。4/8例存活患儿遗留严重颅脑后遗症。结论:IPD致脓毒性休克多见于5岁以下儿童,以血流和颅内感染最常见,对头孢菌素及碳青霉烯类耐药率高。化脓性脑膜炎者易并颅高压危象,致死致残率高,需早期识别并治疗。

Analysis of clinical characteristics and prognosis of children with septic shock caused by invasive pneumococcal diseases

Objective To investigate the clinical characteristics and prognosis of children with septic shock caused by invasive pneumococcal diseases(IPDs)in pediatric intensive care unit(PICU).Methods The clinical data of children diagnosed as septic shock caused by IPDs and hospitalized in the intensive care unit(ICU)of Beijing Children′s Hospital,Capital Medical University and the PICU of Henan Children′s Hospital from January 2013 to August 2019 were retrospectively collected,and the clinical characteristics and prognosis of these patients were analyzed.Results Twenty-one children were included,with a median age of 1.2(0.75,3.90)years old.The pediatric index of mortality 2(PIM-2)at admitting was(23.3±29.6)%,and 6 cases had underlying diseases.Main sites of infection included blood flow(20 cases)and suppurative meningitis(15 cases).The drug sensitivity test was performed on 18 children,among who 9 cases were sensitive to Penicillin,10 cases to Cefepime,11 cases to Cefotaxime and 10 cases to Meropenem.All 18 patients were sensitive to Vancomycin and Linezolid.Seven cases and 13 cases were treated with sensitive antibiotics at the disease onset and before septic shock,respectively.In 21 cases whose lactic acid level was(6.1±4.6)mmol/L,the shock redress time of 10 cases was(10.9±10.1)h,and 13 cases(61.9%)died(14.6±12.2)hours after septic shock,among who 10 died of transforamed magna herniation.The PIM-2 score at admitting into PICU and the rate of intracranial hypertension crisis in the death group were significantly higher than those in the survival group(37.1±30.3)%vs.(0.9±1.3)%,69.9%(9/13 cases)vs.25.0%(2/8 cases)](all P<0.05).There was no significant difference in age and the utilization rate of effective antibiotics before septic shock between the two groups(all P<0.05).Four of the surviving 8 children had severe cerebral functional disability.Conclusions Septic shock caused by IPD is more common in children under 5 years old,and the most common sites are blood flow and intracranial infection.It has high resistance rate against Cephalosporins and Carbopenem.Patients with purulent meningitis are easy to develop intracranial hypertension crisis,which has an extremely high mortality and morbidity,so it needs to be identified and treated early.