无创血流动力学监测在感染性休克患儿早期液体复苏中的应用  

Clinical application of USCOM ultrasonic cardiac output monitoring to liquid resuscitation in children with sepsis

作　　者：梁金鑫[1] 张琪[1] 任晓旭[1] 郭琳瑛[1] 曲东[1] 刘霜[1] 张瑾[1] 

机构地区：[1]首都儿科研究所附属儿童医院急诊科,北京100020

出　　处：《北京医学》2016年第7期698-702,共5页Beijing Medical Journal

基　　金：2010年国家临床重点专科建设补助基金资助项目(财社[2010]305);(2100299)

摘　　要：目的探讨无创超声心排血量监测仪(USCOM)监测在感染性休克早期液体复苏治疗过程中的应用价值。方法选择2010年9月至2015年4月本院急诊室及儿科重症监护病房(PICU)收治的60例感染性休克患儿。随机分为常规治疗组(30例)及观察组(接受USCOM监测)(30例)。两组患儿均按照感染性休克指南给予相应治疗。观察组除接受常规治疗外,根据血流动力学监测调整补液量及血管活性药物剂量。结果两组间治疗前的一般情况差异无统计学意义;液体复苏过程中并发症(脑水肿、肺水肿及心力衰竭)发生率、多器官功能障碍发生率、住院时间差异有统计学意义(P<0.05)。在治疗开始后1 h,观察组患儿的输液量、血气分析(PH、BE)及血乳酸与常规治疗组之间差异有统计学意义;在治疗开始6 h后,2组患儿的尿量、呼吸频率、心率、血气分析(PH)及血乳酸之间差异有统计学意义;观察组患儿的心率、平均动脉压、心输出量(CO)、心脏指数(CI)、每搏输出量(SV)、外周循环阻力指数(SVRI)在休克治疗开始前及开始后第1及第6 h差异均有统计学意义(P<0.05)。结论 USCOM对感染性休克早期的病情判断及治疗效果的评估起到至关重要的作用,可以更准确地指导液体复苏、减少相关并发症、改善预后。Objective To explore the effect of non-invasive ultrasonic cardiac output monitoring（USCOM） on early liquid resuscitation therapy in children with septic shock. Methods We performed a study of 60 children with septic shock admitted to the Emergency Room and Pediatric Intensive Care Unit of the Capital Institute of Pediatrics Affiliated Children＇s Hospital from September 2010 to April 2015. All patients were enrolled and randomly divided into two groups.One is conventional therapy group（n=30） and the other is observation group（under USCOM monitor）（n=30）. Patients in the two groups received treatment in accordance with guidelines for management of septic shock. In the observation group, in addition to standard treatment, doses of fluid infusion and vasoactive drugs were adjusted in accordance with the results of USCOM. Results There was no significant difference between the two groups in general conditions before treatment. During treatment, there was significant difference between the two groups in the occurrence of complications after fluid resuscitation（brain edema, pulmonary edema and heart failure）, multiple organ dysfunction（MODS）, length of time in hospital（P〈0.05）. At 1 hour after treatment, there was significant difference between the two groups in the amount of fluid resuscitation, blood gas analysis（PH, BE）, lactic acid. At 6 hours after treatment, there was significant difference between the two groups in urine output, breathing rate, heart rate, blood gas analysis（PH）, and lactic acid level（P〈0.05）. There was significant difference in heart rate, mean arterial pressure, cardiac output（CO）, cardiac index（CI）,stroke volume（SV） and systemic vascular resistance index（SVRI） of patients in the observation group at three time points（before, 1 hour and 6 hours after treatment）（P〈0.05）. Conclusion Early liquid resuscitation therapy with guidance of USCOM has great clinical value for diagnosis of early septic shock and assessment of therapeu

关 键 词：感染性休克 无创血流动力学监测 儿童 

分 类 号：R720.597[医药卫生—急诊医学]