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儿童脓毒症

最后审阅: 1 Nov 2024
最后更新: 15 Dec 2023

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 发热或体温低
  • 呼吸急促
  • 心动过速
  • 心动过缓(新生儿和婴儿)
  • 精神状态或行为改变
  • 外周灌注下降
  • 新生儿中活动或喂养模式变化
  • 尿片干/尿排出量减少
  • 皮肤斑驳、面色苍白、发绀
  • 低血氧饱和度
  • 血管麻痹
  • 按压不退色的紫癜样皮疹
完整详情

其他诊断因素

  • 低血压
  • 反映基础病变特定的局灶性体征和症状
完整详情

危险因素

  • 免疫缺陷
  • 合并症
  • 男性
  • 较小的年龄(尤其是新生儿)
  • 围产期感染危险因素(新生儿)
  • 保健相关因素(新生儿)
  • 近期手术或其他侵入性操作
  • 皮肤完整性破坏
完整详情

诊断性检查

首要检查

  • FBC 和分类计数
  • 血清葡萄糖
  • 血培养
  • 尿液分析
  • 尿液培养
  • 血气
  • 血清乳酸
  • 血清电解质
  • 血清肌酐
  • 肝功能检查 (LFT)
  • 凝血功能检查
  • C 反应蛋白 (CRP)
  • 胸部 X 线检查
完整详情

需考虑的检查

  • 腰椎穿刺:
  • 脑膜炎球菌聚合酶链反应分析
  • 支气管肺泡灌洗培养
  • 单纯疱疹病毒(herpes simplex virus, HSV)聚合酶链反应(血液和脑脊液)
完整详情

新兴检查

  • 血清原降钙素
  • 新出现的生物标志物
  • PhenoTest™ BC 试剂盒

治疗流程

急症处理

推测或确诊患有脓毒症

撰稿人

作者

Akash Deep, MD, FRCPCH

Director and Professor of Paediatric Critical Care

Paediatric Intensive Care Unit

King’s College Hospital

London

UK

利益声明

AD declares that he has no competing interests.

Chris Duncan, BMBS, BMedSci, MRCP, FFICM, FEWM, RMP, PGCert

Professorial Fellow

Intensive Care Medicine

Nepean Hospital

Sydney

Australia

利益声明

CD declares that he has no competing interests.

鸣谢

Dr Akash Deep and Dr Chris Duncan would like to gratefully acknowledge Dr Jeremy Tong and Dr Adrian Plunkett, previous contributors to this topic.

利益声明

JT and AP are authors involved in the Paediatric Sepsis Six initiative, cited in this topic.

同行评议者

Saul N. Faust, MA, MBBS, FRCPCH, PhD, FHEA

Professor of Paediatric Immunology & Infectious Diseases

Director, NIHR Wellcome Trust Clinical Research Facility

University of Southampton

Southampton

UK

利益声明

SNF declares that he has no competing interests.

Mohan Pammi, MBBS, MD, MRCPCH

Assistant Professor

Texas Children's Hospital and Baylor College of Medicine

Houston

TX

利益声明

MP declares that he has no competing interests.

Jerry J. Zimmerman, MD, PhD

Faculty, Pediatric Critical Care Medicine

Seattle Children's Hospital

University of Washington School of Medicine

Seattle

WA

利益声明

JJZ receives research grant support from NIH/NICHD and ImmuneXpress; travel reimbursement from the Society of Critical Care Medicine to attend board meetings; and royalties from Elsevier for action as a co-editor for the textbook Pediatric Critical Care.

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