小儿心脏重症监护病房中的脓毒症
Sepsis in the pediatric cardiac intensive care unit.
作者信息
Wheeler Derek S, Jeffries Howard E, Zimmerman Jerry J, Wong Hector R, Carcillo Joseph A
机构信息
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
出版信息
World J Pediatr Congenit Heart Surg. 2011 Jul 1;2(3):393-9. doi: 10.1177/2150135111403781.
The survival rate for children with congenital heart disease (CHD) has increased significantly coincident with improved techniques in cardiothoracic surgery, cardiopulmonary bypass and myocardial protection, and perioperative care. Cardiopulmonary bypass, likely in combination with ischemia-reperfusion injury, hypothermia, and surgical trauma, elicits a complex, systemic inflammatory response that is characterized by activation of the complement cascade, release of endotoxin, activation of leukocytes and the vascular endothelium, and release of proinflammatory cytokines. This complex inflammatory state causes a transient immunosuppressed state, which may increase the risk of hospital-acquired infection in these children. Postoperative sepsis occurs in nearly 3% of children undergoing cardiac surgery and has been associated with longer length of stay and mortality risks in the pediatric cardiac intensive care unit. Herein, we review the epidemiology, pathobiology, and management of sepsis in the pediatric cardiac intensive care unit.
随着心胸外科手术、体外循环、心肌保护及围手术期护理技术的改进，先天性心脏病（CHD）患儿的存活率显著提高。体外循环可能与缺血再灌注损伤、低温及手术创伤共同作用，引发复杂的全身炎症反应，其特征为补体级联激活、内毒素释放、白细胞及血管内皮细胞活化以及促炎细胞因子释放。这种复杂的炎症状态会导致短暂的免疫抑制状态，这可能会增加这些患儿发生医院获得性感染的风险。心脏手术后脓毒症发生在近3%的接受心脏手术的儿童中，并且与小儿心脏重症监护病房的住院时间延长及死亡风险相关。在此，我们综述小儿心脏重症监护病房中脓毒症的流行病学、病理生物学及管理。
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