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不同预后及临床特征的脓毒症相关性脑病患儿rScO和ScvO的变化

Changes of rScO and ScvO in children with sepsis-related encephalopathy with different prognoses and clinical features.

作者信息

Guo Jie, Cheng Yibing, Wang Qi, Su Jun, Cui Lidan, Jin Zhipeng

机构信息

Department of Pediatric Intensive Care Unit (PICU), Children's Hospital Affiliated to Zhengzhou University, Zhengzhou Children's Hospital, Zhengzhou Children's Key Laboratory of Critical Care Medicine, Zhengzhou, Henan 450018, P.R. China.

Department of Emergency, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou Children's Hospital, Zhengzhou Children's Key Laboratory of Critical Care Medicine, Zhengzhou, Henan 450018, P.R. China.

出版信息

Exp Ther Med. 2019 May;17(5):3943-3948. doi: 10.3892/etm.2019.7451. Epub 2019 Mar 28.

Abstract

Clinical features of sepsis-associated encephalopathy in children with different prognoses were analyzed and the changes of regional cerebral oxygen saturation (rScO) and central venous oxygen saturation (ScvO) were measured. Eighty children with sepsis-related encephalopathy, admitted to the Pediatric Intensive Care Unit (PICU) of the Children's Hospital Affiliated to Zhengzhou University, were enrolled in this study and post-intensive care syndrome (PICS) scoring was performed within 24 h after admission. Patients were separated into groups according to the score results and treatment outcomes. Clinical features, functional tests, imaging examinations, PICS scores, and modified Glasgow Coma Scale (GCS) scores were compared among children with varying severities and prognoses. The changes of rScO and ScvO at different time-points among children with different prognoses were measured and compared. According to PICS scores, there were 8 non-critically ill children, 42 critically ill children, and 30 extremely critically ill children. Fifty-two children survived, and the survival rate was 65%. Comparison of the clinical characteristics of children with different conditions showed that deep coma, generalized seizure, severe electroencephalogram (EEG) abnormalities, and the survival of children were significantly associated with the severity of disease (P<0.05). At the same time, compared to the survivors group, the rates of generalized seizures and severe EEG abnormalities were significantly increased in the deceased children group, while the PICS and GCS scores were significantly decreased (P<0.05). rScO values in the deceased group were lower than those in the survival group at different time-points, but the differences were not significant (P>0.05). On the contrary, ScvO values were significantly higher in the deceased group than those in the survivors group (P<0.05). The lower the PICS and GCS scores in children with sepsis-related encephalopathy, the more serious the condition, and the more likely to develop disturbance of consciousness, epileptic seizures, and abnormal EEG changes. Whereas, changes of ScvO are closely related to prognosis.

摘要

分析不同预后的儿童脓毒症相关性脑病的临床特征,并测量局部脑氧饱和度(rScO)和中心静脉血氧饱和度(ScvO)的变化。本研究纳入了郑州大学附属儿童医院儿科重症监护病房(PICU)收治的80例脓毒症相关性脑病患儿,并在入院后24小时内进行重症监护后综合征(PICS)评分。根据评分结果和治疗结局将患者分组。比较不同严重程度和预后的儿童的临床特征、功能测试、影像学检查、PICS评分和改良格拉斯哥昏迷量表(GCS)评分。测量并比较不同预后儿童在不同时间点的rScO和ScvO变化。根据PICS评分,有8例非危重症儿童、42例危重症儿童和30例极危重症儿童。52例患儿存活,存活率为65%。不同病情儿童临床特征比较显示,深昏迷、全身性惊厥、严重脑电图(EEG)异常以及儿童存活与疾病严重程度显著相关(P<0.05)。同时,与存活组相比,死亡儿童组全身性惊厥和严重EEG异常的发生率显著升高,而PICS和GCS评分显著降低(P<0.05)。死亡组在不同时间点的rScO值低于存活组,但差异无统计学意义(P>0.05)。相反,死亡组的ScvO值显著高于存活组(P<0.05)。脓毒症相关性脑病患儿的PICS和GCS评分越低,病情越严重,越容易出现意识障碍、癫痫发作和EEG异常改变。而ScvO的变化与预后密切相关。

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