目的:探讨重症监护病房脓毒症患儿的预后情况及其影响因素.方法:选取2015年2月1日至2016年8月1日在广西医科大学第一附属医院儿童重症监护病房(PICU)住院的116例脓毒症患儿作为研究对象.收集患者的临床资料,记录28 d病死率.采用多因素Cox比例风险回归分析影响患儿预后的危险因素.结果:进入PICU 28 d后共有28例(24.1％)患儿死亡.多因素Cox回归模型分析结果显示:25羟基维生素D[25 (OH)D]水平较高是影响预后的保护因素(P＜0.05),第三代小儿死亡危险评分(PRISMⅢ)水平较高是影响预后的独立危险因素(P ＜0.05). 25(OH)D充足组29例中死亡3例(10.3％)、不足组35例中死亡7例(20.0％)、缺乏组52例中死亡18例(34.6％),3组病死率比较差异有统计学意义(P＜0.05);3组平均生存时间分别为25.386 d(95％ CI:22.571～28.201)、23.799 d(95％ CI:20.954～26.644)、20.601 d(95％CI:17.729～23.474).结论:PICU脓毒症患儿的预后情况较差,25(OH)D水平与PICU脓毒症患儿的预后密切相关,提高患儿25(OH)D水平对患儿预后可能具有积极的作用.%Objective:To investigate the prognosis in children with sepsis in pediatric intensive care unit (PICU) and its influencing factor.Methods:The clinical data from 116 children with sepsis admitted to PICU of our hospital from February 1st 2015 to August 1st 2016 were retrospectively analyzed.28-day mortality were recorded.The risk factors influencing prognosis were analyzed by Cox proportional hazards regression.Results:28-day mortality was 24.1％ (28/116).High 25-hydroxyvitamin D [25(OH)D] level was a protection factor,while high pediatric risk of mortality Ⅲ (PRISM Ⅲ) score was an independent risk factor for prognosis in children with sepsis in PICU (P＜0.05).28-day mortality was 10.3％ (3/29) in 25(OH)D sufficiency group,20.0％ (7/35) in insufficiency group and 34.6％ (18/52) in deficiency group.There was significant difference in 28-day mortality among the three groups (P＜0.05).The average survival time in sufficiency,insufficiency and deficiency groups were 25.386 d (95％ CI:22.571-28.201),23.799 d (95％ CI:20.954-26.644),20.601 d (95％ CI:17.729-23.474).Conclusion:The sepsis children in PICU has a poor prognosis.25(OH)D level was closely related to their prognosis,and its high level might improve the clinical outcomes.
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