| Background and purposeSepsis 3.0 is defined as a disorder in the body's response to infection that results in life-threatening organ dysfunction.Sepsis has a high incidence and is one of the main diseases in children's intensive care unit.Although the diagnosis and treatment techniques have been improved in recent years,reducing the mortality rate,it is still an important threat to children's health.The guidelines of Surviving Sepsis Campaign focus on fluid resuscitation,hemodynamics,anti-infection,ventilation and other aspects of treatment,making the treatment of sepsis more standardized,rapid and effective.Frozen plasma is widely used in children with sepsis,even in children without bleeding or invasive operations,but there is lack of evidence and evaluation of frozen plasma for sepsis.Collecting the sepsis cases admitted in pediatric intensive care unit of zhujiang hospital,southern medical university and analysing the usage of frozen plasma,prognosis,this paper would expound the application of frozen plasma in pediatric sepsis,explore the curative effect of frozen plasma in children's sepsis.MethodsThis study was a retrospective study and exempted from ethical review by the hospital medical ethics committee.By retrieving Jiahe electronic medical record system,this study was to collect the sepsis cases admitted in pediatric intensive care unit of Zhujiang hospital,southern medical university from January 1,2014 to June 30,2019,according to the inclusion,exclusion criteria.These cases were divided into groups according to infusion frozen plasma/albumin,and the degree of critical illness.SPSS 20.0 software was used to analyze.Results1.Basic information of the casesA total of 211 cases were included in this study,including 132 males(62.6%)and 79 females(37.4%).The median age was 14(5-36)months,with 88 cases(41.7%)from 1 to 12 months old,followed by 43 cases(20.4%)from 1 to 2 years old,19 cases(9.0%)from 2 to 3 years old,and 71.1%totally.Sepsis was diagnosed in 162 cases(76.8%),severe sepsis in 40 cases(19.0%),and septic shock in 9 cases(4.3%).195 cases(92.4%)survived and 16 cases(7.6%)died.117 cases(55.5%)received infusion of frozen plasma and 94 cases(44.5%)did not.Among the 117 cases of infusion of frozen plasma,77 cases received fresh fresh frozen plasma and ordinary frozen plasma,and 40 cases only received ordinary frozen plasma.A total of 74450ml of frozen plasma was injected,with a median dose of 500(300-800)ml,about 50ml/kg.2.Comparison between the plasma infusion group and the non-plasma infusion groupPatients were divided into infusion group and non-infusion group according to whether or not they received frozen plasma,117 patients received infusion of plasma and 94 patients were not.Comparison of basic admission parameters of the two groups showed that:pSOFA score and hsCRP of the infusion group were higher than that of the non-infusion group(P<0.05),PCIS score of the plasma infusion group was lower than that of the non-plasma infusion group(P<0.05),there were no statistically significant differences in gender,age,Lac,WBC,PLT,INR,and coagulation disorders between the two groups(P>0.05)3.In the patients with pSOFA score?2 points,the mortality rates of the plasma infusion group and the non-plasma infusion group were stratified analysedBased on the definition of Sepsis 3.0,its rapid diagnostic criterion is qSOFA score ?2 points.This study adopted the pSOFA scoring system revised by Matics'version.,and selected 192 cases with pSOFA score?2 points.The pSOFA score ranged from 2-13 points,and the pSOFA score was divided into 4 levels:2-4 points,5-7 points,8-10 points,and 11-13 pointsAccording to whether or not to infuse frozen plasma,it was divided into the infused plasma group and the non-infused plasma group.The mortality rate of the two groups was compared:82 cases were scored 2-4 points by pSOFA,36 cases(43.9%)by infusing plasma,and 0 cases died.There were 46 cases(56.1%)in the non-transfusion group,and 0 cases died.There were 62 cases with pSOFA score of 5-7 points,38 cases(61.3%)with plasma infusion,and 6 cases(15.8%)died.There were 24 cases(38.7%)in the non-transfusion group,and 0 cases died.Statistical analysis showed no statistical difference in mortality between the two groups(P>0.05);There were 33 cases with pSOFA score of 8-10 points,25 cases(75.8%)with plasma infusion,and 3 cases(12%)died.There were 8 cases(24.2%)in the non-transfusion group,and 3 cases died(37.5%).Statistical analysis showed no statistical difference in mortality between the two groups(P>0.05);There were 14 cases with pSOFA score of 11-13 points,12 cases(85.8%)with plasma infusion,and 4 cases(50%)died.There were 2 cases(24.2%)in the non-transfusion group,and 0 cases died.Statistical analysis showed no statistical difference in mortality between the two groups(P>0.05);4.In the survival cases with pSOFA?2 points,the prognosis of the plasma infusion group and the non-plasma infusion group was stratified analysedBased on the definition of Sepsis 3.0,its rapid diagnostic criterion is qSOFA score ?2 points.This study adopted the pSOFA scoring system revised by Matics'version.Set pSOFA<2 points as nomal level.Choosed 175 survival cases with pSOFA?2 points,devided into plasma infusion group and the non-plasma infusion group according to whether received frozen plasma infusion.Stratified as above to analyse two groups' pSOFA score time needed for recovery to normal levels and ICU length of stay.There were 82 cases with pSOFA score of 2-4 points,including 46 patients in the group without plasma infusion.The time required for the pSOFA score to return to the normal level was 3.5(2-5)days,and the ICU length of stay was 6(4-9.25)days.There were 36 patients in the plasma infusion group,the time required for pSOFA score to return to the normal level was 3(2-3)days,and the ICU length of stay was 6(5-8)days.Statistical analysis showed that it took less time for pSOFA score to return to normal level in the plasma infusion group than in the non-plasma infusion group(P<0.05),and no difference in the ICU length of stay(P>0.05).There were 56 cases with pSOFA score of 5-7 points,including 24 patients in the group without plasma infusion.The time required for the pSOFA score to return to the normal level was 9(6-12)days,and the ICU length of stay was 12(9-15.5)days.There were 32 patients in the plasma infusion group,the time required for pSOFA score to return to the normal level was 5(4-7)days,and the ICU length of stay was 8(7-10)days.Statistical analysis showed that it took less time for pSOFA score to return to normal level and the ICU length of stay in the plasma infusion group than in the non-plasma infusion group(P<0.05).There were 27 cases with pSOFA score of 8-10 points,including 5 patients in the group without plasma infusion.The time required for the pSOFA score to return to the normal level was 13(9.5-29)days,and the ICU length of stay was 15(12-31.5)days.There were 22 patients in the plasma infusion group,the time required for pSOFA score to return to the normal level was 7(5-9.25)days,and the ICU length of stay was 8.5(6-11.25)days.Statistical analysis showed that it took less time for pSOFA score to return to normal level and the ICU length of stay in the plasma infusion group than in the non-plasma infusion group(P<0.05).There were 10 cases with pSOFA score of 11-13 points,including 2 patients in the group without plasma infusion.The time required for the pSOFA score to return to the normal level was 15.5 days,and the ICU length of stay was 16.5 days.There were 8 patients in the plasma infusion group,the median time required for pSOFA score to return to the normal level was 8 days,and the median ICU length of stay was 9 days.Statistical analysis showed that it took less time for pSOFA score to return to normal level and the ICU length of stay in the plasma infusion group than in the non-plasma infusion group(P<0.05).5.In the survival cases with pSOFA?2 points,the prognosis of the different components group was stratified analysedChoosed 175 survival cases with pSOFA?2 points,devided into blank group(no plasma/albumin infusion),albumin group,plasma group and albumin+plasma group according to whether or not they were injected with frozen plasma and albumin.Stratified as above to analyse these groups' pSOFA score time needed for recovery to normal levels and ICU length of stayThere were 82 cases with pSOFA score of 2-4 points,including 22 cases in the blank group,24 cases in the albumin group,13 cases in the plasma group and 23 cases in the albumin+plasma group.The average rank of time required for the pSOFA score to return to the normal level were 43.84,50.83,35.42,32.96,the average rank of ICU length of hospital stay was 28.07,51.06,33.65,48.80,statistical analysis found that the time required for pSOFA score to return to the normal level was albumin+plasma group<plasma group<albumin group<blank group,the ICU length of stay was blank group<plasma group<albumin+plasma group<albumin group.There were 56 cases with pSOFA score of 5-7 points,including 6 cases in the blank group,15 cases in the albumin group,7 cases in the plasma group and 28 cases in the albumin+plasma group.The average rank of time required for the pSOFA score to return to the normal level were 39.95,37.14,17.69,22.29,the average rank of ICU length of hospital stay was 40.00,32.21,24.81,22.77,statistical analysis found that the time required for pSOFA score to return to the normal level was plasma group<albumin+plasma group<albumin group<blank group,the ICU length of stay was albumin+plasma group<plasma group<albumin group<blank group.There were 27 cases with pSOFA score of 8-10 points,including 1 cases in the blank group,4 cases in the albumin group,4 cases in the plasma group and 18 cases in the albumin+plasma group.The average rank of time required for the pSOFA score to return to the normal level were 25,22.5,13.38,11.64,the average rank of ICU length of hospital stay was 24.5,22.63,11.88,11.97,Statistical analysis found that the time required for pSOFA score to return to the normal level was albumin+plasma group<plasma group<albumin group<blank group,the ICU length of stay was plasma group<albumin+plasma group<albumin group<blank group.There were 10 cases with pSOFA score of 10-13 points,including 0 cases in the blank group,2 cases in the albumin group,2 cases in the plasma group and 6 cases in the albumin+plasma group.The average rank of time required for the pSOFA score to return to the normal level were-,9.5,5.5,4.17,the average rank of ICU length of hospital stay was-,9.5 5.5,4.17,statistical analysis found that the time required for pSOFA score to return to the normal level and the ICU length of stay were albumin+plasma group<plasma group<albumin group.Conclusions1.Plasma infusion can shorten the course of sepsis in children,facilitate the recovery of the disease,and shorten the length of stay in ICU in more critical children with sepsis,but it does not show significant advantages in improving the mortality.2.Plasma infusion is superior to albumin in shortening the course of sepsis in children,but frozen plasma combined with albumin may be superior in shortening the course of sepsis in children. |
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