36例小儿心源性休克诊治分析  

Diagnosis and treatment of 36 children with cardiogenic shock

作　　者：童凡[1] 刘涛[1] 施丽萍[1] 孙眉月[1] 

机构地区：[1]浙江大学医学院附属儿童医院重症监护病房,杭州310003

出　　处：《中华急诊医学杂志》2006年第6期498-501,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨小儿心源性休克的临床特点、治疗及预后相关因素。方法对36例心源性休克患儿进行回顾性分析。结果起病症状因年龄、原发病不同而异。不同原发病休克出现时间不同,阵发性室上性心动过速(PST)为(62.2±12.9)h,心肌病(CMP)为(42.0±23.0)h,心内膜弹力纤维增生症(ECF)为(20.3±11.1)h,暴发性心肌炎(FMC)为(15.0±7.8)h。休克早期均有心音低钝,15例(41.6%)伴奔马律,17例(47.2%)需心肺复苏。所有病例心脏超声测定射血分数(ejectionfraction,EF)、短轴缩短分数(fractionalshortening,FS)均下降,分别为(0.32±0.11)、(0.14±0.05)。35例(97.2%)有心胸比例增大(0.74±0.04),34例(94.4%)合并心律失常。入院治疗后休克持续时间为预后相关因素(P=0.002,Wald=9.91)。液体复苏在严密监测下进行,ECF、FMC、CMP复苏液量分别为5.25ml·kg-1·h-1、4.48ml·kg-1·h-1、4.75ml·kg-1·h-1。结论小儿心源性休克临床表现多样,病情凶险。早期做床边心脏超声、胸片、心电图检查有助诊断。治疗后休克持续时间为判断预后的指标。治疗除针对原发因素外,液体复苏亦有其特殊性。Objective To explore the clinical characteristics, treatment and prognostic factors of cardiogenic shock in children. Methods A retruspeetive analysis was done on clinical features, management strategies and outcome in 36 children with eardiogenie shock in Intensive Care Unit of our hospital from February 1994 to December 2005. Results The clinical presentations of 36 patients varied with the different ages and different primary diseases. And the duration between the presentation and the onset of shock varied with the different primary diseases： the duration for paroxysmal supraventrieular taehyeardia （PST） was （62.2 ± 12.9） hours, eardiomyopathy （CMP） was （42.0 ± 23.0） hours, endocardial fibroelastosis （ECF） was （20.3 ± 11.1 ） hours, and fulminant myocarditis （FMC） was （15.0±7.8） hours. At theearly stage of shock, all patients showed soft heart sounds. Gallop rhythm was found in 15 eases （41.6%） and cardiopulmonary resuscitation was needed in 17 cases （47.2%）. All cases had decreased ejection fraction （EF） and fractional shortening （FS） [ （0.32 ± 0.11 ）, （0.14 ± 0.05）, respectively] on eehocardiography. Cardiothoraeie ratio increased in 35 eases （97.2%） and arrhythmia developed in 34 eases （94.4%）. The duration from initial treatment to shock correction of was related to the prognosis （ P = 0.002, Wald = 9.91 ）. Fluid resuscitation in eardiogenie shock needed close monitor, and the amount of fluid was 5.25 ml·kg^-1·h^-1 , 4.48 ml·kg^-1·h^-1 , 4.75ml·kg^-1·h^-1 in ECF, FMC and CMP, respectively. Conclusion The clinical presentations high in eardiogenie shock in children were various. Early bedside echocardingram, chest X-ray and electrocardiogram would be helpful in diagnosis. The duration from initial treatment to shock correction was a strong prognostic factor for eardiogenie shock. Compared with other kinds of shock, fluid resuscitation had its features.

关 键 词：儿童 心源性休克 临床特点 预后 治疗 

分 类 号：R720.597[医药卫生—急诊医学]