Long-term Health Status in Childhood Survivors of Meningococcal Septic Shock
Long-term Health Status in Childhood Survivors of Meningococcal Septic Shock
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DOI：
10.1001/archpedi.162.11.1036
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发表时间：
2008-11-01
影响因子：
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通讯作者：
Joosten, Koen F. M.
中科院分区：
文献类型：
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作者：
Buysse, Corinne M. P.;Raat, Hein;Joosten, Koen F. M.
目的：评价儿童期脑膜炎球菌感染性休克患者的长期健康状况。设计：横断面队列的医学和心理随访。环境：一所三级大学医院的儿科重症监护室（PICU）。参与者：1988年至2001年间所有需要重症监护的感染性休克和紫癜患者。干预措施：患者及家长于PICU出院后4 - 16年随访。结果测量：健康状况通过标准医学访谈、体格检查、肾功能检查和健康效用指数2 （HUI2）和3 （HUI3）进行评估。结果：120例患者（有效率71%）参加了随访（PICU入院时中位年龄为3.1岁；中位随访间隔为9.8年；中位随访年龄为14.5岁）。35%的患者有以下一种或多种神经损伤：严重智力低下伴癫痫（3%）、听力损失（2%）、慢性头痛（28%）和局灶性神经症状（6%），如单臂麻痹。16例脓毒性休克相关急性肾衰竭患者中有1例在PICU入院时表现出轻度慢性肾衰竭的迹象(肾小球滤过率，62 mL/min/1.73 m；蛋白尿;和高血压)。与荷兰人口数据相比，几乎所有HUI2和HUI3属性的得分都显着降低，表明这些患者的健康状况较差。结论：在儿童期脑膜炎球菌感染性休克存活的患者中，三分之一表现出从轻度到重度和不可逆的长期神经损伤。患者报告的总体健康状况较差，以HUI2和HUI3衡量。
Objective: To assess long-term health status in patients who survived meningococcal septic shock in childhood.Design: Medical and psychological follow-up of a cross-sectional cohort.Setting: Pediatric intensive care unit (PICU) of a tertiary care university hospital.Participants: All consecutive patients with septic shock and purpura who required intensive care between 1988 and 2001.Intervention: Patients and their parents were invited to our follow-up clinic 4 to 16 years after PICU discharge.Outcome Measures: Health status was assessed with a standard medical interview, physical examination, renal function test, and the Health Utilities Index Mark 2 (HUI2) and 3 (HUI3).Results: One hundred twenty patients (response rate 71%) participated in the follow-up (median age at PICU admission, 3.1 years; median follow-up interval, 9.8 years; median age at follow-up, 14.5 years). Thirty-five percent of patients had 1 or more of the following neurological impairments: severe mental retardation with epilepsy (3%), hearing loss (2%), chronic headache (28%), and focal neurological signs (6%), like paresis of 1 arm. One of the 16 patients with septic shock-associated acute renal failure at PICU admission showed signs of mild chronic renal failure (glomerular filtration rate, 62 mL/min/1.73 m(2); proteinuria; and hypertension). Scores were significantly lower on nearly all HUI2 and HUI3 attributes compared with Dutch population data, indicating poorer health in these patients.Conclusions: In patients who survived meningococcal septic shock in childhood, one-third showed long-term neurological impairments, ranging from mild to severe and irreversible. Patients reported poorer general health as measured by HUI2 and HUI3.