摘要目的 探讨儿科重症监护病房(PICU)患儿的新发功能障碍发病率及功能状态.方法 回顾性病例观察性研究,总结2015年1月至2016年1月中国医科大学附属盛京医院PICU收治的所有患儿资料,在入院时和出院时分别进行功能状态评分(FSS),并计算出院与入院FSS的差值(ΔFSS),统计新发功能障碍发生率、病死率,根据入院FSS分为正常组(6~7分)、轻度异常组(8~9分)、中度异常组(10~15分)、重度异常组(16~21分)、极重度异常组(22~30分).根据原发病分为循环系统组、泌尿系统组、外科组、消化系统组、神经系统组、呼吸系统组、血液系统组、中毒组、其他组.根据FSS的评分项目分为Δ神志FSS组、Δ感觉FSS组、Δ沟通FSS组、Δ运动FSS组、Δ喂养FSS组、Δ呼吸FSS组.分别应用χ2检验、t检验、方差分析进行组间比较.结果 研究期间共收治928例危重患儿,其中男561例、女367例,年龄(31.1±1.3)月龄.共有82例(8.8%)患儿发生新发功能障碍,12例(1.3%)患儿死亡.轻、中、重、极重度异常组的出院FSS、ΔFSS、新发功能障碍百分率均高于正常组[(7.09±0.27)、(8.86±0.28)、(13.56±0.88)、(18.68±0.99)比(6.38±0.17)分,t=2.36、6.56、12.29、18.15;(-1.39±0.27)、(-2.76±0.28)、(-4.39±0.88)、(-6.59±0.91)比(-0.20±0.17)分,t=3.93、6.91、7.13、10.10;7.2%(12/170)、10.6%(38/359)、24.6%(19/79)、10.9%(10/91)比1.3%(3/229),χ2=7.39、17.14、42.43、13.27;P均<0.05].原发病分组中新发功能障碍发病率由高到低依次为循环系统组、外科组、消化系统组、神经系统组、呼吸系统组、血液系统组和中毒组[27.3%(24/88)、9.2%(6/65)、8.2%(8/97)、7.7%(23/299)、6.9%(17/248)、3.9%(2/51)、0(0/61),χ2=37.75,P<0.05];以上各组间入院FSS、出院FSS、ΔFSS差异均有统计学意义(F=13.56、8.97、10.84,P均<0.05),Δ神志FSS、Δ感觉FSS、Δ沟通FSS、Δ运动FSS、Δ喂养FSS、Δ呼吸FSS比较,差异亦均有统计学意义(F=6.30、7.37、7.84、7.47、9.97、10.50,P均<0.05).结论PICU的新发功能障碍发病率较高,新发功能障碍组患儿病死率较高.出院时功能状态与入院时功能状态密切相关.循环系统疾病患儿新发功能障碍的发生率最高,功能状态恶化程度最大.对于原发病为严重的循环系统疾病、消化系统疾病、血液系统疾病患儿需要注意其呼吸、运动功能状态改变.

abstractsObjective To investigate the incidence and clinical characteristics of new-onset organ dysfunction of patients in pediatric intensive care unit (PICU).Method A retrospective observational study identified all patients admitted to the PICU of Shengjing Hospital Affiliated to China Medical University from January 2015 to January 2016.The functional status score (FSS) was evaluated at admission and hospital discharge respectively,and the difference defined as ΔFSS between the FSS at hospital discharge and the FSS at admission was calculated.According to the initial FSS,the patients were divided into normal group (6-7 scores),mildly abnormal group (8-9 scores),moderate abnormal group (10-15 scores),severe abnormal group (16-21 scores) and extreme severe abnormal group (22-30 scores).According to the primary disease,all cases were divided into cardiovascular disease group,urinary disease group,surgery group,digestive disease group,neurological disease group,respiratory disease group,hematological disease group,poisoning group and other group.According to the FSS domain,all cases were divided into mental status group,sensory group,communication group,motor group,feeding group,respiratory group.The incidence of new-onset organ dysfunction,the case fatality rate and the FSS of each group were calculated.Comparisons were performed using a chi-square test,t test and analysis of variance.Result The study population included 928 patients (561(60.5%) male,mean age (31.1±1.3) months).The incidence of new-onset organ dysfunction was 8.8%(82/928) and the case fatality rate was 1.3%(12/928).The FSS at hospital discharge(scores),ΔFSS (scores) and the incidence of new-onset organ dysfunction were significantly less in patients in the normal group (6.38±0.17,-0.20±0.17 and 1.3%(3/229),respectively) compared to patients in the mildly abnormal group (7.09±0.27,-1.39±0.27 and 7.2%(12/170),respectively,t=2.36,3.93,χ2=7.39,all P<0.05),patients in the moderately abnormal group (8.86±0.28,-2.76±0.28 and 10.6%(38/359),t=6.56,6.91,χ2=17.14,all P<0.05),patients in the severely abnormal group(13.56±0.88,-4.39±0.88 and 24.6%(19/79),t=12.29,7.13,χ2=42.43,all P<0.05) and patients in the extreme severely abnormal group(18.68±0.99,-6.59±0.91 and 10.9%(10/91),t=18.15,10.10,χ2=13.27,all P<0.05).Significant difference was found regarding the incidence of new-onset organ dysfunction among patients in cardiovascular disease group (27.3%,24/88),surgery group (9.2%,6/65),digestive disease group (8.2%,8/97),neurological disease group (7.7%,23/299),respiratory disease group (6.9%,17/248),hematological disease group (3.9%,2/51) and toxic group (0,0/61) (χ2=37.75,all P<0.05).There were significant differences among primary disease groups regarding the FSS at admission,the FSS at hospital discharge,ΔFSS,Δmental status FSS,Δsensory FSS,Δcommunication FSS,Δmotor FSS,Δfeeding FSS,and Δrespiratory FSS (F=13.56,8.97,10.84,6.30,7.37,7.84,7.47,9.97,10.50,all P<0.05).Conclusion The incidence of new-onset organ dysfunction in PICU was high.The case fatality rate in patients with new-onset organ dysfunction was high.The functional status at hospital discharge was strongly associated with the functional status at admission.Patients in the cardiovascular disease group had the highest incidence of new-onset organ dysfunction and the most severe deterioration of functional status.More attention must be paid to motor function and respiratory function in cardiovascular disease,respiratory disease and hematological disease.