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目的观察脓毒症患儿并毛细血管渗漏综合征(CLS)的临床特点。方法回顾性分析2001-2010年在本院住院治疗的35例脓毒症并CLS患儿的临床表现、辅助检查特点及治疗、预后情况,对常见致病菌进行药物敏感试验以观察其对抗生素的敏感性,指导临床用药。结果 CLS的发病率有逐年上升趋势。35例患儿均有全身急性进行性水肿及血压下降,呼吸困难27例,意识障碍15例,少尿8例,肉眼血尿5例,肾功能不全12例,均存在低清蛋白血症,尿常规均可见蛋白尿及镜下血尿,胸腔积液28例,腹腔积液26例,心包积液10例。引起儿童脓毒症并CLS最常见的致病菌为革兰阴性杆菌(24例,占85.7%),其对头孢哌酮/舒巴坦钠、亚胺培南、呋喃妥因耐药率低(<15%)。CLS治疗中积极控制感染和补充胶体液尤为关键。结论 CLS具有特殊的病理生理特点和临床表现,只有进行正确的诊断、细致的监测及恰当的治疗才能最大程度地提高治疗效果和改善预后。
Objective To observe the clinical features of children with sepsis and capillary leak syndrome (CLS). Methods Retrospective analysis of clinical manifestations, auxiliary examination features and treatment, prognosis of 35 cases of sepsis and CLS children hospitalized in our hospital during 2001-2010 were retrospectively analyzed. Drug-susceptibility tests of common pathogenic bacteria were conducted to observe the effect on antibiotics The sensitivity of clinical guidance. Results The incidence of CLS increased year by year. Thirty-five children had acute progressive edema and decreased blood pressure, 27 cases of dyspnea, 15 cases of disturbance of consciousness, 8 cases of oliguria, 5 cases of gross hematuria and 12 cases of renal insufficiency. All had hypoproteinemia, Conventional proteinuria and microscopic hematuria were seen, pleural effusion in 28 cases, 26 cases of ascites, pericardial effusion in 10 cases. Gram-negative bacilli (24 cases, accounting for 85.7%) caused the most common pathogens of sepsis and CLS in children. The rates of cefoperazone / sulbactam, imipenem and nitrofurantoin were low (< 15%). Positive control of CLS treatment and colloidal fluid supplement is particularly critical. Conclusion CLS has special pathophysiological features and clinical manifestations. Only with proper diagnosis, careful monitoring and appropriate treatment can CLS improve the treatment effect and prognosis.