Abstract: Objective　To explore the risk factors for the occurrence of capillary leak syndrome（CLS） in children with sepsis,in order to find grounds for early screening and timely treating the children with sepsis at higher risk.Methods　A total of 321 children with sepsis admitted to the Department of Pediatrics of Hainan General Hospital from June 2007 to June 2015 were selected and divided into group without CLS （n=298） and group combined with CLS （n=23） in accordance with whether they had CLS.The period of observation for the children was between the admission time and discharge time.And during the period,we observed and compared the following between the two groups:clinical treatment results,age,gender,prevalence of malnutrition,white blood cell （WBC） count,serum procalcitonin （PCT） level,serum C-reactive protein（CRP）level,incidence of fasting blood glucose≥6.67 mmol/L,serum tumor necrosis factor-α（TNF-α） level,serum lactate level,occurrence of coagulation disorders,pediatric critical illness score（PCIS）,prevalence of shock,incidence of multiple organ dysfunction syndrome（MODS） affecting 3 or more organs,usage rates of antibiotics treatment within 1 hour,and early goal-directed therapy within 6 hours.Multivariate Logistic regression analysis was used to analyze the influencing factors of CLS in children with sepsis.Results　The clinical cure rate in the group without CLS was significantly higher than that in the group combined with CLS （χ2=41.309，P<0.001）.The differences in terms of age,gender,prevalence of malnutrition,WBC count,usage rates of antibiotics treatment within 1 hour and early goal-directed therapy within 6 hours between the two groups were not statistically significant（P>0.05）.Compared with the group without CLS,group combined with CLS had higher serum levels of PCT,CRP,TNF-α and lactate,higher prevalences of fasting blood glucose≥6.67 mmol/L,coagulation disorders,shock,and MODS affecting 3 or more organs,and lower PCIS（P<0.05）.The results of multivariate Logistic regression analysis showed that the risk factors for the occurrence of CLS in children with sepsis were as follows:serum lactate level〔OR=2.609，95%CI（1.402,4.857）,P<0.05〕,PCIS〔OR=0.634,95%CI（0.497,0.808）,P<0.05〕,shock〔OR=0.124，95%CI（0.024,0.643）,P<0.05〕 and MODS affecting 3 or more organs〔OR=0.120，95%CI（0.021,0.676）,P<0.05〕.Conclusion　Children with sepsis who have the risk factors as elevated serum lactate level,decreased PCIS,shock and MODS affecting 3 or more organs are apt to suffer from CLS.Intensively monitoring should be given to them as early as possible.

Key words: Sepsis, Capillary leak syndrome, Risk factors

摘要： 目的　探讨脓毒症并发毛细血管渗漏综合征（CLS）的危险因素,为临床早期筛查、及时干预提供理论依据。方法　收集2007年6月—2015年6月海南省人民医院儿科收治的321例脓毒症患儿的临床资料，根据是否并发CLS将患儿分为非CLS组298例和CLS组23例。以患儿入院为观察起点，死亡或出院为观察终点。比较两组患儿临床治疗结果及年龄、性别、营养不良发生情况、白细胞计数（WBC）、血清降钙素原（PCT）水平、血清C反应蛋白（CRP）水平、空腹血糖≥6.67 mmol/L发生情况、血清肿瘤坏死因子α（TNF-α）水平、血清乳酸水平、凝血功能障碍发生情况、小儿危重症评分（PCIS）、休克发生情况、多器官功能障碍综合征（MODS）累及脏器≥3个发生情况、脓毒症治疗1 h内抗生素应用情况及6 h目标复苏治疗情况；采用多因素Logistic回归分析脓毒症患儿并发CLS的影响因素。结果　非CLS组患儿治愈率高于CLS组患儿（χ2=41.309，P<0.001）。两组患儿年龄、性别、营养不良发生率、WBC、脓毒症治疗1 h内抗生素应用率、6 h目标复苏治疗率比较，差异无统计学意义（P>0.05）；CLS组患儿血清PCT水平、血清CRP水平、血糖≥6.67 mmol/L发生率、血清TNF-α水平、血清乳酸水平、凝血功能障碍发生率、休克发生率、MODS累及脏器≥3个发生率高于非CLS组，PCIS低于非CLS组（P<0.05）。多因素Logistic回归分析结果显示，血清乳酸水平〔OR=2.609，95%CI（1.402，4.857）〕、PCIS〔OR=0.634，95%CI（0.497，0.808）〕、休克〔OR=0.124，95%CI（0.024，0.643）〕、MODS累及脏器≥3个〔OR=0.120，95%CI（0.021，0.676）〕是脓毒症患儿发生CLS的影响因素（P<0.05）。结论　血清乳酸水平升高、PCIS降低、休克、MODS累及脏器≥3个的脓毒症患儿发生CLS的可能性较大，临床应注意重点监测。

关键词: 脓毒症, 毛细血管渗漏综合征, 危险因素