| 宋 林,邹 惠,曾 玲,刘 旭,吴莎莉.脓毒症患儿预后的影响因素分析及pSOFA评分、PCIS评分及早期血乳酸测定的预测价值探讨[J].,2023,(3):494-499 |
| 脓毒症患儿预后的影响因素分析及pSOFA评分、PCIS评分及早期血乳酸测定的预测价值探讨 |
| Analysis of Prognostic Factors in Children with Sepsis and Investigate the Predictive Value of pSOFA Score, PCIS Score and Early Blood Lactate Determination |
| 投稿时间：2022-05-06 修订日期：2022-05-30 |
| DOI：10.13241/j.cnki.pmb.2023.03.019 |
| 中文关键词: 脓毒症 儿童 儿科序贯器官衰竭评分 小儿危重病例评分 血乳酸 预后 |
| 英文关键词: Sepsis Children Pediatric sequential organ failure assessment Pediatric critical illness score Blood lactate Prognosis |
| 基金项目:湖南省医药卫生科研基金资助项目（B20170479） |
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| 中文摘要: |
| 摘要 目的：分析脓毒症患儿预后的影响因素，并探讨儿科序贯器官衰竭评估（pSOFA）评分、小儿危重病例评分法（PCIS）评分及早期血乳酸（Lac）测定对预后的预测价值。方法：选取2020年1月～2022年5月我院儿童医学中心收治的107例脓毒症患儿，根据脓毒症患儿28 d生存情况分为死亡组48例和存活组59例。收集患儿临床资料，对患儿进行pSOFA评分、PCIS评分评价和血Lac检测。采用单因素和多因素Logistic回归分析脓毒症患儿死亡的影响因素，受试者工作特征（ROC）曲线分析pSOFA评分、PCIS评分和血Lac水平对脓毒症患儿死亡的预测价值。结果：107例脓毒症患儿28 d死亡率为44.86％（48/107）。死亡组脓毒症分级、合并器官损伤≥3个比例、机械通气比例、pSOFA评分、白细胞计数、D-二聚体、C反应蛋白、降钙素原、血Lac水平高于存活组，机械通气时间长于存活组，PCIS评分、血小板计数、白蛋白水平低于存活组（P＜0.05）。多因素Logistic回归分析显示，严重脓毒症、脓毒性休克、合并≥3个器官损伤、机械通气、pSOFA评分增加、D-二聚体升高、血Lac升高为脓毒症患儿死亡的独立危险因素，PCIS评分增加、白蛋白升高为独立保护因素（P＜0.05）。ROC曲线分析显示，pSOFA评分、PCIS评分和血Lac水平联合预测脓毒症患儿死亡的曲线下面积大于各指标单独预测。结论：脓毒症分级、合并器官损伤、机械通气、D-二聚体、白蛋白、pSOFA评分、PCIS评分、血Lac为脓毒症患儿预后的影响因素，pSOFA评分、PCIS评分和血Lac水平联合预测脓毒症患儿死亡风险的价值较高。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the prognostic factors in children with sepsis, and to investigate the predictive value of pediatric sequential organ failure assessment (pSOFA) score, pediatric critical illness score (PCIS) score and early blood lactate (Lac) determination for prognosis. Methods: 107 children with sepsis who were admitted to the children's medical center of our hospital from January 2020 to May 2022 were selected, they were divided into 48 cases in the death group and 59 cases in the survival group according to the 28 d survival in children with sepsis. Clinical data of children were collected, and the children were evaluated by pSOFA score, PCIS score and blood Lac. Single and multivariate Logistic regression were used to analyze the influencing factors of death in children with sepsis, and the predictive value of pSOFA score, PCIS score and blood Lac level on death in children with sepsis were analyzed by receiver operating characteristic (ROC) curve. Results: The 28 d mortality rate of 107 children with sepsis was 44.86% (48/107). The sepsis grade, combined organ injury greater than or equal to 3 ratios, mechanical ventilation ratio, pSOFA score, leukocyte count, D-dimer, C-reactive protein, procalcitonin and blood Lac level in the death group were higher than those in the survival group, and the mechanical ventilation time was longer than that in the survival group, and the PCIS score, platelet count and albumin level were lower than those in the survival group (P<0.05). Multivariate Logistic regression analysis showed that severe sepsis, septic shock, combined with greater than or equal to 3 organ injuries, mechanical ventilation, increased pSOFA score, elevated D-dimer and elevated blood Lac were independent risk factors for death in children with sepsis, and increased PCIS score and elevated albumin were independent protective factors (P<0.05). ROC curve analysis showed that the area under the curve of pSOFA score, PCIS score and blood Lac level jointly predicting the death in children with sepsis was greater than that predicted by each index alone. Conclusion: The sepsis grade, combined organ injury, mechanical ventilation, D-dimer, albumin, pSOFA score, PCIS score, and blood Lac were the prognostic factors in children with sepsis, and the combined prediction value of the pSOFA score, PCIS score and blood Lac level is high in the risk of death in children with sepsis. |
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