RESUMO
Objective:To analyze clinical factors related to nosocomial infection in children with extracorporeal membrane oxygenation(ECMO)support.Methods:General data, infection data and relevant factors in children with ECMO support in Bayi Children′s Hospital, the 7 th Medical Center of People′s Liberation Army General Hospital and Henan Provincial People′s Hospital from September 2012 to February 2020 were reviewed.Relevant factors of nosocomial infection in them were analyzed. Results:Among 163 cases, 36(22.1%) children supported with ECMO had infections during the period of ECMO, and 72 pathogenic microorganisms were detected, including 67 bacteria (33 Acinetobacter baumannii, 21 Klebsiella pneumoniae, and 6 Pseudomonas aeruginosa) and 5 fungi.Pathogens from the respiratory system, blood system, urinary tract and abdominal cavity were detected in 45 cases(62.5%), 25 cases (34.7%), 1 case (1.4%), and 1 case (1.4%), respectively.Drug sensitivity analysis of the Acinetobacter baumannii showed that it was the extensively resistant strain.Compared with uninfected children supported with ECMO, ECMO support time[(10.0±6.7) d], hospitalization[(34.0±25.3) d], hospitalization cost[(234 368±113 234) yuan], preoperative oxygenation index(52.8±23.0) and lactate value[(9.6±5.9) mmol/L]were significantly higher in nosocomial infection ones[(4.6±3.2) d, (24.3±19.8) d, (161 416±65 847) yuan, 35.6±10.4, (5.6±5.4) mmol/L] supported with ECMO (all P<0.05). There was no significant difference in the mortality between 2 groups ( P>0.05). In addition, lactate level (9.8 mmol/L) and oxygenation index (36.0±12.7) were significantly higher in died children(2.7 mmol/L, 22.1±10.4) with nosocomial infection during the period of ECMO support than those of survivors (all P<0.05). Multivariate Logistic regression analysis showed that ECMO support time( OR=7.054, 95% CI: 2.206-25.525) and preoperative lactate value( OR=2.250, 95% CI: 1.378-4.611) were independent risk factors of nosocomial infection. Conclusions:Correcting underlying diseases of ECMO supporting and shortening the duration of ECMO can reduce the incidence and mortality of nosocomial infection in children who are supported with ECMO.
RESUMO
Objective:To evaluate the efficacy and mechanism of continuous blood purification(CBP) in the treatment of severe sepsis in children.Methods:A total of 42 patients with severe sepsis were enrolled in the study.According to the parents undefined desire to treatment, on the basis of the same treatment condition, 30 cases in the blood purification group were treated with CBP, and 12 cases in the control group were given the routine treatment without CBP treatment.The difference of each index between the two groups at the baseline(before treatment) and 72 hours after treatment were observed.Results:The differences of heart rate, mean arterial pressure and brain natriuretic peptide before and after treatment in the blood purification group were significantly higher than those in control group( P<0.05), and the differences of oxygenation index, 24-hour average urine volume, blood urea nitrogen, creatinine and Glasgow coma score in the blood purification group were significantly higher than those in control group( P<0.05). The difference of capillary refill time, lactic acid and central venous oxygen saturation in blood purification group were significantly higher than those in control group( P<0.05). The level of white blood cell count, C-reactive protein, procalcitonin and interleukin-6 in blood purification group were significantly higher than those in control group, with all significant difference( P<0.05). There was significant difference in critical illness score between two groups after treatment and before treatment.The mortality rate of the blood purification group was significantly lower than that in control group( P<0.01). Conclusion:CBP can improve cardiovascular function, brain function, renal function, tissue perfusion, inflammation index, internal environment, and improve the score of children with severe sepsis.