LIN Xiaofei1 GU Xiaohai1 YU Chunlin1 ZHU Hongli1 WU Yunduo1 ZHANG Jun1 WANG Yumei2
1.Department of Pediatrics, the Huai’an Maternity and Child Clinical College of Xuzhou Medical University, Jiangsu Province, Huai’an 223002, China;
2.Neonatal Disease Screening Center, the Huai’an Maternity and Child Clinical College of Xuzhou Medical University, Jiangsu Province, Huai’an 223002, China
Abstract:The early diagnosis and treatment of sepsis has always been the focus of pediatric critical illness. In recent years, the World Health Organization (WHO) bring forth the concept of “integrated intervention of prevention, diagnosis and clinical treatment”. A group of authoritative experts in the field of emergency treatment in China have also taken the lead in projecting the “prevention of sepsis campaign in China” (PSCC), but how to effectively coordinate and deal with relevant issues in clinical work, especially how to make early accurate diagnosis and take bundle strategy of intensive treatment for the later stage is still a hot issue that needs active attention. In this paper, some new reaearch and related progress of the diagnostic methods of children sepsis, such as biomarkers, multi-dimensional scoring methods, physiological parameters and variables of diagnostic significance, and the prediction system of mechanical sepsis are reviewed in order to provide reference for early diagnosis and accurate treatment of children sepsis in the future, and to offer assistance for clinicians.
[1] Singer M,Deutschman CS,Seymour CW,et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)[J]. JAMA,2016,315(8):801-810.
[2] Dellinger RP,Levy MM,Rhodes A,et al. Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup. Surviving Sepsis Campaign:international guidelines formanagement of severe sepsis and septic shock,2012 [J]. Crit Care Med,2013,41(2):580-637.
[3] Rhodes A,Evans LE,Alhazzani W,et al. Surviving Sepsis Campaign:International Guidelines for Management of Sepsis and Septic Shock:2016 [J]. Intensive Care Med,2017, 43(3):304-377.
[4] Fleischmann C,Scherag A,Adhikari NK,et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations [J]. Am J Respir Crit Care Med,2016,193(3):259-272.
[5] Wang Y,Sun B,Yue H,et al. An epidemiologic survey of pediatric sepsis in regional hospitals in China [J]. Pediatr Crit Care Med,2014,15(9):814-820.
[6] Hartman ME,Linde-Zwirble WT,Angus DC,et al. Trends in the epidemiology of pediatric severe sepsis [J]. Pediatr Crit Care Med,2013,14(7):686-693.
[7] Farris RW,Weiss NS,Zimmerman JJ. Functional outcomes in pediatric severe sepsis:further analysis of the researching severe sepsis and organ dysfunction in children:a global perspective trial [J]. Pediatr Crit Care Med,2013, 14(9):835-842.
[8] Als LC,Nadel S,Cooper M,et al. Neurophysiological function three to six months following admission to the PICU withmeningoencephalitis,sepsis and other disorders:a pro-spective study of school-aged children [J]. Crit Care Med,41(4):1094-1103.
[9] 程晔,应佳云,刘彦婷,等.《2020拯救脓毒症运动国际指南:儿童脓毒性休克和脓毒症相关器官功能障碍管理》解读[J].中国小儿急救医学,2020,27(4),241-248.
[10] Weiss SL,Peters MJ,Alhazzani W,et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children [J]. Pediatr Crit Care Med,2020,21(2):e52-e106.
[11] Cho SY,Choi JH. Biomarkers of sepsis [J]. Infect Chemother,2014,46(1):112.
[12] 王承娟,祝益民,张新萍,等.儿童脓毒症生物标记物的研究进展[J].中国小儿急救医学,2017,24(11):864-869.
[13] 曹露露,朱晓东.儿童脓毒症诊断标志物的临床应用[J].中国小儿急救医学,2017,24(7):507-511.
[14] 张芳,王莹,宁铂涛,等.长链非编码RNA在儿童脓毒症中表达的初步研究[J].中国小儿急救医学,2018,25(5):356-361.
[15] 肖婷,陈丽萍,黄晓华,等.sCD14-ST在儿童脓毒症早期诊断中的应用[J].中华检验医学杂志,2016,39(4):251-255.
[16] 曾萍,刘琳,何艳娟,等.内生吗啡对儿童脓毒症的诊断价值[J].中国当代儿科杂志,2018,20(8):623-628.
[17] Wang C,Cui Y,Miao H,et al. Apolipoprotein A-V Is a Novel Diagnostic and Prognostic Predictor in Pediatric Patients with Sepsis:A Prospective Pilot Study in PICU [J]. Mediators Inflamm,2020:8052954.
[18] Pierrakos C,Vibcent JL. Sepsis biomarkers:a revivw [J].Crit Care,2010,14(1):R15.
[19] Goldstein B,Giroir B,Randolph A. International pediatric sepsis consensus conference:defifinitions for sepsis and organ dysfunction in pediatrics [J]. Pediatric Crit Care Med,2005,6(1):2-8.
[20] 侯红云,刘昶,魏军,等.机械通气患者早期APACHEⅡ评分及血清降钙素原水平与预后的关系[J].临床和实验医学杂志[J],2019,18(12):1317-1320.
[21] Dhainaut IF,Yan SB,Joyce DE,et al. Treatment effectsofdrotrecogin alfa(aetivated)inpatientswithsevere sepsiswithor withoutOvertdisseminatedintravascularcoagulat-ion [J]. J Thromb Hacmost,2004,2(11):1924-1933.
[22] Leteurtre S,Duhamel A,Salleron J,et al. PELOD-2:an update of the pediatric logistic organ dysfunction score [J]. Crit Care Med,2013,41(7):1761-1773.
[23] Schlapbach LJ,Straney L,Bellomo R,et al. Prognostic accuracy of age-adapted SOFA,SIRS,PELOD-2,and qSOFA for inhospital mortality among children with suspected infection admitted to the intensive care unit [J]. Intensive Care Med,2018,44(2):179-188.
[24] 于航,朝鲁门其其格.PCT、Hs-CRP水平联合PCIS评分在儿童脓毒症中的诊断价值[J].贵州医科大学学报,2018,43(9):1101-1104.
[25] 李娟珍,王莹.PICU中儿童脓毒症临床特点和预后相关因素分析[J].临床儿科杂志,2017,35(10):762-768.
[26] 孙世心,何颜霞.儿童脓毒症相关性脑病发生和死亡的危险因素分析[J].中国小儿急救医学,2016,23(8):543-546.
[27] 金林梅,齐霁,李玉梅,等.脓毒症3.0在儿童脓毒症诊断的运用——我们还有很多工作要做[J].中国小儿急救医学,2017,24(7):486-490.
[28] Calvert JS,Price DA,Chettipally UK,et al. A computational approach to early sepsis detection [J]. Comput Biol Med,2016,74:69-73.
[29] Calvert J,Desautels T,Chettipally U,et al. High-performance detection and early prediction of septic shock for alcohol-use disorder patients [J]. Ann Med Surg (Lond),2016,8:50-55.
[30] Desautels T,Calvert J,Hoffman J,et al. A machine learning approach to sepsis prediction in the intensive care unit with minimal electronic health record data [J]. JMIR Med Inform,2016,4(3):e28.
[31] Henry KE,Hager DN,Pronovost PJ,et al. A targeted real-time early warning score(TREWScore)for septic shock [J]. Sci Transl Med,2015,7(299):299ra122.
[32] Nachimuthu SK,Haug PJ. Early detection of sepsis in the emergency department using Dynamic Bayesian Networks [J]. AMIA Annu Symp Proc,2012,2012:653-662.
[33] Dyagilev K,Saria S. Learning(predictive)risk scores in the presence of censoring due to interventions [J]. Mach Learn,2016,102:323-348.
[34] Le S,Hoffman J,Barton C. Pediatric Severe Sepsis Prediction Using Machine Learning [J]. Front Pediatr,2019, 11(7):413.
[35] 刘广建,李晓君,李庆丰,等.临床表型数据和医学知识驱动的儿童脓毒症亚型识别[J].中国数字医学,2019, 14(3):66-69.
[36] 陈潇,钱娟.神经网络和因子分解机的儿童脓毒症辅助诊断系统[J].科学技术与工程,2017,17(22):265-270.