多器官功能障碍综合征在儿科重症监护室第1天的结局

中国小儿急救医学 Pub Date : 2019-09-20 DOI:10.3760/CMA.J.ISSN.1673-4912.2019.09.102

方伯梁, 钱素云

引用次数: 0

摘要

The purpose of this article is to describe the current outcome of multiple organ dysfunction syndrome (MODS) in PICU on the first day of admission. Design: Retrospective observational cohort study site: Admission records from the Virtual Pediatric Systems (VPS) database between January 2014 and December 2015. Object: This article analyzed 194017 consecutive PICU admitted children (aged 1 month to 18 years) in the VPS database from January 2014 to December 2015. Intervention: This article adopts the standards of the International Pediatric Sepsis Consensus Conference to confirm the MODS on Day 1 based on laboratory and vital sign values on Day 1. Evaluate functional status through the Pediatric Overall Performance Classification (POPC) and Pediatric Brain Function Classification (PCPC) scores at PICU admission and discharge. Measurement method and main results: The overall mortality rate of PICU was 2.1%. This article confirms that 14.4% of admitted cases develop MODS on the first day. The mortality rate of MODS patients is higher than that of non MODS patients (10.3% vs 0.7%, P<0.001), and the proportion of surviving patients with PCPC (3.6% vs 0.5%, P<0.001) or POPC (6.0% vs 1.8%, P<0.001) score deterioration ≥ grade 2 is higher. The odds ratio of mortality in MODS patients on the first day was 14.3 (95% CI 13-15.7), while the odds ratio of death or discharge with a POPC/CPC score of ≥ 3 (poor functional prognosis) was 6.7 (95% CI 6-7.4). The research subset was from 148 188 pediatric patients who recorded restrictive support decision hospitals, which was found in 5.8% of MODS patients, while only 0.8% of patients without MODS (P<0.001). On the first day of death, 43.1% of MODS patients received restrictive support decisions, and 41.6% gave up life support treatment (P<0.001). Conclusion: MODS patients on the first day of admission are still the main source of mortality and disability in PICU, but the risk of poor neurological prognosis may be improved. Further research is needed on restrictive support strategies and decisions to discontinue life support therapy in children with MODS on day 1.

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Outcomes of Day 1 Multiple Organ Dysfunction Syndrome in the Pediatric Intensive Care Unit

目的本文旨在描述PICU入院第1天出现多器官功能障碍综合征(multiple organ dysfunction syndrome，MODS)的结局现状。设计：回顾性观察性队列研究场所： 2014年1月至2015年12月间虚拟儿科系统(Virtual Pediatric Systems，VPS)数据库的入院记录。对象：本文分析了2014年1月至2015年12月VPS数据库中的194 017个连续PICU入院患儿(年龄1个月～18岁)。干预：本文采用国际儿科脓毒症共识会议标准按照第1天实验室和生命体征数值确认第1天MODS。通过PICU入院和出院时的儿科总体表现分类(POPC)和儿科脑功能表现分类(PCPC)评分评估功能状况。测量方法和主要结果： PICU总体病死率2.1%。本文确认14.4%入院病例第1天发生MODS。MODS患儿病死率高于无MODS者(10.3%比0.7%，P<0.001)，存活者PCPC(3.6%比0.5%，P<0.000 1)或POPC(6.0%比1.8%，P<0.001)评分恶化≥2级比例更高。第1天发生MODS患儿病死的优势比为14.3(95%CI 13-15.7)，而病死或出院时POPC/PCPC评分≥3(功能预后差)的优势比为6.7(95%CI 6-7.4)。研究子集来自记录限制性支持决策医院的148 188例患儿，该决策见于5.8%MODS患儿，而无MODS者仅0.8%(P<0.001)。病死的第1天MODS患儿中，43.1%接受限制性支持决策，41.6%放弃生命维持治疗(P<0.001)。结论：入院第1天MODS患儿仍是PICU中病死和残疾的主要病例来源，但神经预后不良的风险可能会得到改善。需要进一步研究第1天MODS患儿的限制性支持策略和停止生命维持治疗的决策。

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来源期刊

中国小儿急救医学

自引率

0.00%

发文量

6226

期刊介绍： Chinese Journal of Neurology was established in 1955, the predecessor of which is Chinese Journal of Neurology and Psychiatry. Chinese Journal of Neurology and Psychiatry has been indexed by MEDLINE until 1996, when it was divided into two journals, Chinese Journal of Neurology, and Chinese Journal of Psychiatry. Chinese Journal of Neurology is now indexed by EM, SCOPUS, AJ, WPRIM, CNKI, Wanfang Data, CSCD, etc. The impact factor of the journal is 2.755 in 2017, ranking the first among all neurological and psychological journals in China and among all the 142 medical journals published by the Chinese Medical Association. The journal is available both in print and online.