3％高渗盐水在儿童脓毒性休克早期液体复苏中的作用  

Effect of 3% hypertonic saline as early fluid resuscitation in pediatric septic shock

作　　者：刘霜[1] 任晓旭[1] 郭琳瑛[1] 张琪[1] 张瑾[1] 祝益民[2] 

机构地区：[1]首都儿科研究所附属儿童医院重症医学科,北京100020 [2]湖南省人民医院

出　　处：《中华儿科杂志》2015年第8期599-604,共6页Chinese Journal of Pediatrics

基　　金：“十二五”国家科技支撑计划（2012BAI04800）

摘　　要：目的与传统生理盐水复苏相比较，探讨3％高渗盐水在儿童脓毒性休克早期液体复苏中的作用。方法前瞻性研究，采用随机数余数分组法，将首都儿科研究所附属儿童医院重症监护病房2012年1月至2014年1月收治的脓毒性休克患儿44例（男33例，女11例），分为生理盐水复苏组（Ns组，24例）、3％高渗钠复苏组（HS组，20例），经静脉通路输入相应复苏液体，同时进行规范的抗休克治疗。监测液体复苏前后心率、平均动脉压（MAP）、动脉血乳酸、氧合指数（OI，=PaO2／FiO2）、尿量、血钠，计算24h乳酸清除率；记录24h输液量、正性肌力药物评分，小儿危重评分（PCIS）变化，机械通气时间，多器官功能障碍综合征发生率以及28d死亡率。结果（1）复苏后NS组和HS组心率、MAP较复苏前明显改善，两组间各时间点的心率、MAP比较差异无统计学意义。（2）与复苏前OI比较，HS组复苏后3h明显改善[（321．8±50．7）比（296．5±58．2）mmHg（1mmHg=0．133kPa），t=-2．50，P=0．018]，Ns组复苏后24h改善[（325．7±62．6）比（304．2±70．4）mmHg，t=-2．60，P=0．016]，两组各时间点OI比较差异无统计学意义。（3）HS组复苏后1h血钠高于NS组[（138．3±3．8）比（135．0±3．5）mmol／L，t=8．77，P=0．005]，随后两组血钠浓度差异无统计学意义。（4）HS组6h及24h输液量（ml／kg）较NS组明显减少[6h：（39．2±13．9）比（60．8±22．4），t=14．21，P=0．000；24h：（102．9±27．7）比（130．6±33．2），t=8．85，P=0．005]。两组6h、24h尿量比较差异无统计学意义（P〉0．05）。（5）两组24h乳酸清除率、24hPCIS、正性肌力药物评分、机械通气时间比较差异无统计学意义。两组多器官功能障碍综合征发生率（HS组80．O％，NS组70．0％）及28d死亡率（HS组5．0％，NS组8．3％）比较，差异无统计学意义。结论3％高渗�Objective The mainstay of therapy in patients with septic shock is early and aggressive intravenous fluid resuscitation. However the type of intravenous fluid that would be ideal for managing septic shock has been intensely debated. In this study, the authors observed the effects of 3% hypertonic saline solution compared with normal saline solution as early fluid resuscitation in children with septic shock. Method In this prospective study, 44 septic shock children seen in the intensive care unit （ICU） of the Children＇s Hospital Affiliated to Capital Institute of Pediatrics were enrolled from January 2012 to January 2014, of whom 33 were male and 11 were female. Patients were randomly divided into two groups ： normal saline group （NS group,24 patients） and 3% hypertonic saline group （HS group,20 patients）. There were no significant differences between the 2 groups of patients in age, gender, pediatric critical illness score （PCIS）, oxygenation index （OI = PaO2/FiO2）, arterial lactate, initial hemodynamic parameters, serum sodium and treatment at time of admission. Patients in NS group received normal saline guided by standardtherapy. Those in HS group received 6 ml/kg 3% hypertonic saline as a single bolus over 10 min to 15 min with a maximum of 2 boluses and other standard therapy. Heart rate （ HR）, mean arterial blood pressure （MAP）, arterial lactate, oxygenation index, urine output, serum sodium, lactate clearance rate, PCIS, fluid infusion volume, vasoactive - inotropic score, mechanical ventilation time , as well as incidence of multiple organ dysfunction syndrome （MODS） , and 28 days in - hospital mortality were recorded for all patients. Result （1）HR, MAP in both groups were significantly higher after infusion than those on admission. There were no significant difference in HR and MAP at lh, 3h, 6h and 24h after infusion between NS group and HS group. （2） OI in HS group was significantly higher than that on admission at 3 hours after infusion [ （ 321.8 ± 50. 7

关 键 词：脓毒性休克 高渗盐水 补液疗法 血流动力学 儿童 

分 类 号：R720.597[医药卫生—急诊医学]