Abstract: Objective　To investigate the clinical characteristics and influencing factors of prognosis of PICU children with septic shock. Methods　According to the 2015 version of China's Expert Consensus on the Diagnosis and Treatment of Septic Shock （Septic Shock） in Children，a  total of 104 children with septic shock who were admitted to the PICU Ward of Shengjing Hospital of China Medical University from January 2015 to December 2019 were screened out.  Study the onset status and clinical characteristics of septic shock in children， and at the same time through univariate analysis and Logistic regression analysis，learn about the independent risk factors related to the prognosis of septic shock. Results　There were 104 children diagnosed with septic shock in the 5 years，accounting for 2% of the PICU hospitalized children during the same period. Among them，60 were boys and 44 were girls. The median age was 8 months，and infants and young children accounted for 77.9%（81 /104）; the overall mortality rate was 55.8%（58/104）; the digestive tract was the most common site of infection（48.1%），followed by the respiratory system（ 23.1%）; the proportion of confirmed pathogenic bacteria was 45.2%（47/104）；children with confirmed bacterial infection were gram-negative bacilli and gram-positive cocci；the top three bacteria were Escherichia coli，Pseudomonas aeruginosa and Streptococcus pneumoniae. Among 47 specimens with confirmed pathogen infection，42 cases were tested for drug sensitivity，and the drug resistance rate was 92.9%（39/42）. nivariate analysis suggested that mechanical ventilation，vasoactive drug use，respiratory and cardiac arrest，coagulation function，blood glucose，lactate，albumin，VIS score，PRISM score，PCIS score，and oxygenation index（P/F）≤300 were related to the death of children with septic shock;multivariate stepwise logistic regression showed that mechanical ventilation，respiratory and cardiac arrest and oxygenation index ≤300 were independent risk factors for death in septic shock，and albumin >30 g/L was a protective factor. Conclusion　The fatality rate of septic shock in PICU children is extremely high. The primary disease should be treated actively，and mechanical ventilation and vasoactive drugs should be used rationally to improve lung function and maintain hemodynamic stability. Enhancing management of mechanical ventilation and correcting hypoalbuminemia may be effective ways to reduce the mortality rate.

Key words: child, septic shock, intensive care unit, clinical features, prognosis

摘要： 目的　探讨儿科重症监护病房（PICU）脓毒性休克患儿的临床特点与预后影响因素。方法　按照我国2015版《儿童脓毒性休克（感染性休克）诊治专家共识》筛选出2015年1月至2019年12月中国医科大学附属盛京医院PICU病房的脓毒症休克患儿104例。研究其发病现状、临床特点，同时通过单因素分析和Logistic回归分析，了解与脓毒性休克预后转归相关的独立危险因素。结果　5年间共有104 例患儿诊断脓毒性休克，占PICU同期住院患儿的2%（104/5201）。其中男60例，女44例，中位年龄为8月龄，婴幼儿占77.9% （ 81/104）。总病死率55.8% （ 58 /104）；消化道是最常见原发感染部位（ 48.1% ），其次是呼吸系统（ 23.1% ）。明确病原菌感染者47例（45.2%， 47/104）；细菌感染患儿中以革兰阴性杆菌和革兰阳性球菌为主，排名前三的细菌为大肠埃希菌、铜绿假单胞菌及肺炎链球菌。47例明确病原菌感染的标本中有42例进行药敏试验，耐药率为92.9% （39/42）。单因素分析提示机械通气、血管活性药使用、呼吸心跳骤停、凝血功能、血糖、乳酸、白蛋白、血管活性药物评分（VIS）、儿童死亡风险评分（PRISM评分）、儿童危重病例评分（PCIS评分）及氧合指数（P/F）≤300与脓毒症休克患儿死亡相关；多因素逐步 Logistic 回归显示：机械通气、呼吸心跳骤停和氧合指数≤300是脓毒性休克的死亡独立危险因素，白蛋白>30 g/L是保护因素。结论　PICU脓毒性休克患儿病死率极高，应积极治疗原发病，合理使用机械通气及血管活性药改善肺功能并维持血流动力学稳定。加强机械通气管理及纠正低白蛋白血症，处理好这些预后影响因素可能是减低病死率的有效方式。

关键词: 儿童, 脓毒症休克, 重症监护病房, 临床特点, 预后