脓毒性休克液体复苏中血浆胶体渗透浓度监测的应用价值研究  

Plasma colloid osmotic pressure monitoring in fluid resuscitation of pediatric patients in septic shock

作　　者：卜会驹[1] 林小茂[1] 温海洋[1] 陈亮[1] 

机构地区：[1]中山大学附属东华医院ICU,广东东莞523110

出　　处：《中国实用儿科杂志》2010年第8期642-645,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨血浆胶体渗透浓度(COP)监测在脓毒性休克液体复苏中的应用价值。方法 2005年11月至2009年6月中山大学附属东华医院重症监护室收住的脓毒性休克患儿47例,随机分为两组,均动态监测血浆胶体渗透浓度,并进行液体复苏。其中A组22例,不以胶体渗透浓度测定值作为参考指标,根据临床经验补液,即快速输液阶段采用生理盐水,继续和维持输液阶段晶体液:胶体液为2～3∶1。B组25例,动态监测测胶体渗透浓度,如低于正常,快速输液阶段采用较多胶体液,继续和维持输液阶段采用晶体液:胶体液为1∶1,如胶体渗透浓度正常,处理同A组。记录两组患儿平均动脉压(MAP),每小时尿量,中心静脉压(CVP),复苏液量,血管活性药用量,小儿危重病例评分(PCIS评分)等指标变化,并作统计学分析。结果两组患儿入科时COP,PCIS评分,MAP,CVP差异均无统计学意义,COP明显低于正常值范围。B组各时段胶体用量,COP均大于A组。第6、24hB组用的液体总量比A组少,第1、6hB组PCIS评分,每小时尿量,MAP,CVP均大于A组,各种血管活性药物用量均少于A组。第24h两组PCIS评分,每小时尿量,MAP,CVP无明显差别,但是B组各种血管活性药物用量少于A组。结论小儿脓毒性休克液体复苏中动态监测COP,以此依据调整复苏液的晶体胶体比例,可有效提高疗效。Objective： To research the advantages of plasma colloi,d osmotic pressure （COP） monitoring in fluid resuscitation of pediatric patients in septic shock. Methods A total of 47 pediatric patients in septic shock were divided randomly into 2 groups; all cases were dynamically monitored COP, and under went fluid resuscitation. In Group A （22 cases）, fluid infused depending on clinical experience, and COP indexes were not considered. Only normal sodium was used in quick transfusion period. Crystal vs colloid fluid was 2 - 3 ： 1 during continuing and sustaining transfusion period. In Group B （25 cases） , if COP was lower than normal, more colloid fluid was used in quick transfusion period and Crystal vs colloid fluid was 1 ： 1 during continuing and sustaining transfusion period ; otherwise , treatments were the same as in group A. Average artery pressure （MAP）, urine volume per hour, central venous pressure （cvp）, fluid resuscitation volume, usage amount of vasoactive drug, and pediatric critical illness scores （PCIS scores） of two groups were recorded and statistically analyzed. Results At first, COP, PCIS scores, MAP and CVP were similar between group A and B ; COP was obviously lower than normal. Colloid fluid volume and COP of group B in every period were more than group A. Total fluid volume of group B during 6 and 24 hours were less than group A ; at 1 and 6 hour, PCIS scores, urine volume per hour, MAP and CVP of group B were more than group A, usage amount of vasoactive drug was less＇than group A. After 24 hours, PCIS scores, urine volume per hours, MAP, CVP were similar between group A and B, but in group B usage amount of vasoactive drug was less than that in group A. Conclusion Monitoring COP during fluid resuscitation of pediatric patients in septic shock, and adjusting ctystal colloid proportion depending on it , was helpful to increase curative effect.

关 键 词：血浆胶体渗透浓度 脓毒性休克 液体复苏 

分 类 号：R72[医药卫生—儿科]