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作 者:王晓冬[1] 霍习敏[1] 徐梅先[1] 耿文锦[1] 郭艳梅[1] 曹利静[1] 孙慧[1] 石晓娜[1] 李君娥[1] 史海燕[1] 李攀[1] 康磊[1]
机构地区:[1]河北省儿童医院重症监护科,石家庄050031
出 处:《中华危重病急救医学》2013年第4期207-210,共4页Chinese Critical Care Medicine
基 金:河北省医药卫生研究重点课题(20100196)
摘 要:目的观察儿童脓毒性休克早期抗感染治疗的临床价值。方法回顾性分析重症医学科收治的80例脓毒性休克患儿的集束化治疗,按照第1次抗菌药物使用时间将患儿分为两组,于入院后1h内开始抗感染治疗者作为观察组,入院后1~6h抗感染治疗者作为对照组,每组40例。对比两组患儿人院时、入院后24h及72h血乳酸、C-反应蛋白(CRP)、降钙素原(PCT)等水平。结果观察组入院后24h乳酸明显低于对照组(mmol/L:8.65±2.84比11.75±3.20,P〈0.01),入院后24h和72hCRP明显低于对照组(mg/L:66.25±8.55比91.77±7.71,22.03±7.46比50.11±7.30,均P〈0.01),入院后72hPCT明显低于对照组(斗g/L:0.67±0.31比1.16±0.25,P〈0.01)。观察组休克持续时间较对照组明显缩短(h:6盘0±3.70比12.804-3.63,P〈0.05),但病死率差异无统计学意义[5%(2/40)比10%(4/40),P〉0.05]。结论给予脓毒性休克患儿早期经验性抗感染治疗可以缩短休克持续时间,更早发挥抗炎抗休克的作用,从而提升脓毒性休克抢救成功率。Objective To investigate the value of timing of antibiotics in pediatric septic shock. Methods Eighty children with septic shock treated with bundle treatment in Department of Critical Care Medicine were retrospectively analyzed. Eighty children with septic shock were divided into observation group (u = 40, anti-infection therapy within 1 hour after admission ) and control group (n=40, anti-infection therapy 1-6 hours after admission ). The contents of lactate, C-reaction protein (CRP) and procaleitonin (PCT) were compared between two groups at admission and 24 hours and 72 hours after admission. Results Lactate in the observation group was significantly lower than that of the control group within the first 24 hours after admission (retool/L: 8.65 ± 2.84 vs. 11.75 ± 3.20, P〈0.01 ). CRP in the observation group was significantly lower than that of the control group 24 hours and 72 hours after admission (mg/L: 66.25 ±8.55 vs. 91.77 ±7.71, 22.03 ±7.46 vs. 50.11 ±7.30, both P〈0.01). PCT in the observation group was significantly lower than that of the control group 72 hours after admission (Ixg/L: 0.67 ± 0.31 vs. 1.16 ± 0.25, P〈0.01 ). Time for shock recovery in the observation group was significantly shorter than that of the control group (hours : 6.80 .± 3.70 vs. 12.80 ± 3.63, P〈0.05), but no statistical difference in mortality rate between groups was found [5% (2/40) vs. 10% (4/40), P〉0.05]. Conclusion With the early empirical anti-infection treatment in pediatric septic shocked patients, time for recovery from shock can be shortened and successful rate of resuscitation can be improved.
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