重症超声指导儿童脓毒性休克液体复苏的临床意义  

Clinical significance of critical care ultrasound in guiding fluid resuscitation in children with septic shock

作　　者：陈志旭[1] 阮俊贤 林益虎 沈美丽 许成娜 林春裕 朱广福 林志斌[1] CHEN Zhixu;RUAN Junxian;LIN Yihu;SHEN Meili;XUChengna;LIN Chunyu;ZHU Guangfu;LIN Zhibin(Department of Intensive Medicine,Quanzhou Children's Hospital,QuanZhou 362000,China)

机构地区：[1]泉州市儿童医院重症医学科,福建泉州362000 [2]泉州市儿童医院超声科,福建泉州362000 [3]不详

出　　处：《中国急救复苏与灾害医学杂志》2021年第1期76-78,82,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：泉州市科技计划项目(编号:2018Z161)。

摘　　要：目的研究重症超声指导儿童脓毒性休克液体复苏的临床意义。方法将泉州市儿童医院2018年6月-2019年6月间收治的78例脓毒性休克患儿纳为研究对象,采用随机数字表法将其均分为常规组(常规体液复苏,n=39)与观察组(重症超声指导下体液复苏,n=39),观察两组治疗效果。结果治疗12h后,两组患儿中心静脉压(central venous pressure CVP)显著上升(P<0.05),心率(heart rate,HR)显著下降(P<0.05),平均动脉压(meanarterial pressure,MAP)无显著性改变(P>0.05),两组CVP.HR,MAP水平无显著性差异(P>0.05)。治疗12h后,两组中心静脉血氧饱和度(ScvO2)显著上升(P<0.05),乳酸(Lac)及中心静脉二氧化碳分压(Pv-aCO2)水平显著下降(P<0.05),两组治疗12h后ScvO2、Lac及Pv-aCO2水平无显著性差异(P>0.05)。与常规组相比,观察组血管活性药物使用频率、剂量均明显低于对照组(P<0.05),其机械通气时间明显短于对照组(P<0.05)。两组ICU入住时间、总住院时间、7d及28 d死亡率无显著性差异(P>0.05)。结论重症超声能准确指导脓毒症性休克患儿液体复苏,有利于临床诊治。Objective To study the clinical significance of critical care ultrasound in guiding fluid resuscitation in chil-dren with septic shock.Methods A total of 78 children with septic shock who were admitted Quanzhou Children's Hos-pital were conducted to this study in between June 2018 and June 2019.Control group(conventional fluid resuscitation,n=39)and observation group(eritical care ulrasound in guiding fluid resuscitation,n=39)were divided according torandom number table methods.The clinical efficacy was compared between two groups.Results The central venouspressure(CVP)was significantly increased(P<0.05),heart rate(HR)was significantly decreased(P<0.05),and no sig-nificant change was found in mean arterial pressure(MAP)in both groups(P>0.05)after 12h of treatment.There was nosignificant difference inCVP.HR and MAP between two groups(P>0.05).After 12h of treatment,the central venous ox-ygen saturation(ScvO.)was increased significantly(P<0.05),while the lactic acid(Lac)and central venous-to-arterialcarbon dioxide difference(Pv-aCO,)level were decreased significantly in both groups(P<0.05).ScvO,Lac and Pv-aCO,levels at 12h after treatment had no significant difference between two groups(P>0.05).The frequency and doseof vasoactive drugs in observation group were significantly shorter than those in control group(P<0.05).The duration ofmechanical ventilation in the observation group was significantly shorter than that in control group(P<0.05).There wasno significant difference in ICU stay time,total hospitalization time,and 7d and 28d mortality rates between two groups(P>0.05).Conclusion Critical care ultrasound could accurately guide fluid resuscitation in children with septic shockwhich is beneficial to the clinical treatment.

关 键 词：脓毒症休克 液体复苏 重症超声 

分 类 号：R720.597[医药卫生—急诊医学]