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目的了解PICU危重患儿发生急性胃肠功能衰竭的病因、流行病学特点和死亡危险因素。方法总结1999年1月~2004年12月我院PICU危重患儿急性胃肠功能衰竭的病因、预后与多器官功能衰竭(MODS)的关系,对死亡危险因素进行单因素分析。结果1788例危重患儿中569例发生急性胃肠功能衰竭,病死率29·3%,6年间病死率无明显变化(χ2=0·357,P=0·896)。严重感染、严重低氧血症和酸中毒、意外伤害、急性脑功能障碍是急性胃肠功能衰竭的常见病因,分别占39·4%、27·9%、16·7%和16·0%。对9种死亡因素进行统计学分析结果表明年龄、入院当天的危重病评分值、合并的基础疾病、血红蛋白显著下降、胃液pH值、血糖浓度异常、严重低氧血症和酸中毒、合并器官功能衰竭数目和休克与病死率显著相关(P<0·05或P<0·001)。结论1999年以来,急性胃肠功能衰竭病死率依然很高。严重感染、严重低氧血症和酸中毒、意外伤害、急性脑功能障碍是其发生的主要危险因素;患儿年龄小于1岁、危重病评分低及合并MODS是其死亡的主要危险因素。除治疗原发疾病、调整内环境、改善微循环外,还可通过提供最佳营养支持、维护胃肠黏膜屏障及外科治疗等措施,以期降低急性胃肠功能衰竭患儿的病死率。
Objective To understand the etiology, epidemiology and risk factors of acute gastrointestinal failure in critically ill children with PICU. Methods From January 1999 to December 2004, the relationship between the cause and prognosis of acute gastrointestinal failure and the multiple organ failure (MODS) in critically ill children with PICU in our hospital from January 1999 to December 2004 were analyzed univariately. Results Of the 1788 critically ill children, 569 cases had acute gastrointestinal failure with a mortality rate of 29.3%. There was no significant difference in the 6-year mortality rate (χ2 = 0 · 357, P = 0.086). Severe infection, severe hypoxemia and acidosis, accidental injury, acute brain dysfunction are common causes of acute gastrointestinal failure, accounting for 39.4%, 27.9%, 16.7% and 16.0% . The statistical analysis of 9 death factors showed that age, critical illness score on admission day, combined underlying disease, significant decrease in hemoglobin, gastric juice pH, abnormal blood glucose levels, severe hypoxemia and acidosis, combined organ function The number of failures and shock were significantly associated with mortality (P <0.05 or P <0.001). Conclusion Since 1999, the mortality rate of acute gastrointestinal failure is still high. Severe infection, severe hypoxemia and acidosis, accidental injury and acute brain dysfunction are the main risk factors. Children younger than 1 year, low critical illness score and combined MODS are the major risk factors for their death. In addition to treating primary diseases, adjusting the internal environment and improving microcirculation, we can reduce the case fatality rate in children with acute gastrointestinal failure by providing the best nutritional support, maintaining the gastrointestinal mucosal barrier and surgical treatment.