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《Chinese Journal of Emergency Medicine》 2006-06
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Septic shock and multiple organ dysfunction syndrome from gastroenteritis in children

ZHANG Yucai, ZHANG Yuming,XU Liang,TANG Dinghua. Intensive Care Unit ,Children's Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200040,China  
Objective To study the etiology, clinical features, risk factors of septic shock and multiple organ dysfunction syndrome /multiple organ failure (MODS/MOF) caused by gastroenteritis infection in the pediatric intensive care unit (PICU). Methods Case records of patients with gastroenteritis complicated by septic shock and MODS/MOF admitted to PICU in Children's hospital affiliated to Shanghai Jiaotong University from January 2000 to December 2004 were reviewed for etiology, case fatality rate, prognosis and relationship with MODS/MOF. Univariate analyses were performed to analyse the risk factors associated with septic shock and MODS/MOF. Results During the 5 years, 1 536 patients with critical illness were admitted and MODS/MOF associated with gastroenteriitis infection developed in 28 patients. The overall mortality of patients with MODS/MOF associated with gastroenteriitis was 75%. The mean age was (1.9±3.4)years and 19 cases(67.8%)were under 1 year. The patients with MODS/MOF involved (3.7±0.9)organs or systems on average. The numbers of involved organs systems were circulatory in 28 patients(100%), gastrointestinal system in 21(75%), lung in 20(71.4%), kidney in 14(50%),brain in 9(32.4%),blood in 9(32.4%) and liver in 5(17.9%). The first dysfunctional system was gastrointestinal tract in 13(46.4%),circulatory in 11(39.3%),and lung in 4(14.3%). The average volume of fluid resuscitation was (46.2±12.6)ml/kg and range from 30 ml/kg to 75 ml/kg in the first hour. The average fluid was (92.7±33.9)ml/kg and range from 70 ml/kg to 120 ml/kg in 6 hours. The cases fatality of patients with or without successful volume resuscitation were 66.7% (12 in 18 cases) and 90%(9 in 10 cases) in 6 hours respectively.Univariate analyses indicated the following risk factors: numbers of failed organ and lower pediatric critical illness score(P0.05 or P0.01). Conclusion The patients with MODS/MOF associated with gastroenteritis infection in children had the following features:The events occurred in young age and most commonly in infancy. The disease progression was rapid the with poor outcome and higher mortality rate. The volume required for resuscitation was more than usual. The lower cases fatality might be possible in patients with successful volume resuscitation in 6 hours.
【CateGory Index】: R720.597
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