早期综合加强治疗策略抢救小儿脓毒症器官功能不全临床研究.docVIP

早期综合加强治疗策略抢救小儿脓毒症器官功能不全临床研究 　　【摘要】 目的 探讨脓毒症器官功能不全患儿的早期综合加强治疗策略。方法 对2006年3月至2008年7月期间的39例脓毒症器官功能不全患儿,根据其临床表现,评估其所处的全身炎症反应综合征/代偿性抗炎症反应综合征(SIRS/CARS)平衡状态,按个体化原则采用不同强度的扩容、血管活性药物、抗感染、糖皮质激素、呼吸支持、大剂量静脉免疫球蛋白、大剂量血浆、小剂量肝素、细胞因子拮抗剂、中医中药等综合治疗。并与2004年6月至2006年2月期间收治的30例同类患儿应用常规治疗方法结果进行比较。结果 观察组39例存活35例,死亡4例,死亡率10.25%;对照组30例存活21例,死亡9例,死亡率30.00%。两组比较χ2=4.32,P 　　【关键词】 脓毒症;SIRS/CARS失衡;治疗;免疫调整 　　 　　Clinical study of early comprehensive and intensive therapy on the sepsis with organ dysfunction in Children 　　WUYang, ZHU Ling, LIN Guangyu, et al.Department of Pediatrics, Second Affiliated Hospital of Shantou University Medical College, Shantou 515041,China 　　【Abstract】 Objective To explore the strategy of early comprehensive and intensive therapy on the sepsis with organ dysfunction in children. Methods From Mar.2006 to July 2008, the 39 patients who were diagnosed sepsis with organ dysfunction, according to their clinical manifestation,were evaluated the balanced condition of systemic inflammatory response syndrome/compensatory antiinflammatory response syndrome (SIRS/CARS). Then the different intensity of combined therapy such as fluid expansion,vasoactive agent,antiinfection,glucocorticoid,respiration sustain,highdose injective vein immune globulin,largedose blood plasma,lowdose heparin,cytokine antagon,and therapy of traditional chinese medicine were taken by individual principles. Moreover, the early comprehensive and intensive therapy was compared with the conventional therapy to 30 patients with the similar disease from Jun. 2004 to Feb. 2006.Results Among 39 observed patients, 35 patients survived and 4 patients died, the mortality rate was 10.25%. On contrary, 21 patients survived and 9 patients died in 30 control patients, the mortality rate was 30.00%. Compared the observed group with the control group, χ2=4.32,P 　　1.3.2 对照组 2004年6月至2006年2月期间本科收治的脓毒症患儿共30例,其中男21例,女9例;??龄1~12月16例,1~3岁6例,4~7岁5例,8~14岁3例;原发病:重症肺炎5例,重症毛细支气管炎4例,急性肠炎、重度脱水、循环衰竭5例,化脓性脑膜炎3例,病毒性脑炎4例,重度营养不