床旁重症超声对休克患儿的诊治价值研究  

Diagnosis and treatment value of bedside severe ultrasound in children with shock

作　　者：程超[1] 杨妮[1] 裴亮[1] 胡杨[1] 吴瑕[1] 王丽杰[1] 许巍[1] 刘春峰[1] Cheng Chao;Yang Ni;Pei Liang;Hu Yang;Wu Xia;Wang Lijie;Xu Wei;Liu Chunfeng(Department of Pediatrics,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院儿内科,沈阳110004

出　　处：《中国小儿急救医学》2021年第1期40-44,共5页Chinese Pediatric Emergency Medicine

摘　　要：目的探讨床旁重症超声对休克患儿的诊断及治疗价值。方法选择2019年5月1日至2020年4月31日中国医科大学附属盛京医院PICU收治的休克患儿,并对休克患儿应用休克患者快速超声评估(rapid ultrasound in shock,RUSH)方案进行心肺及腹部形态、功能评估,以辅助休克诊断及治疗。结果26例休克患儿,入院时立即根据RUSH方案进行评估,诊断为脓毒性休克8例,心源性休克6例,低血容量性休克6例,混合性休克6例。心源性休克患儿左室射血分数(26.5±8.24)%,下腔静脉宽度均大于10 mm,休克纠正后左室射血分数上升至(32.17±26.11)%。脓毒性休克患儿入院时左室射血分数(73.25±1.28)%,休克纠正时左室射血分数(50.12±31.41)%。26例休克患儿液体复苏1 h后9例(34.6%)肺部超声发现较多B线;其中,心源性休克液体复苏1 h后约50%患儿肺部超声发现较多B线,存活患儿休克纠正后11例(57.9%)出现较多B线,但仅有6例患儿查体可闻及水泡音。结论根据RUSH方案对休克患儿容量状态、心脏功能、容量反应性及病灶进行评估,结合病史及其他临床资料,更早更准确地分辨休克类型并辅助指导液体复苏,利于患儿的精确、个体化液体管理和治疗。Objective To evaluate the diagnostic and therapeutic value of bedside severe ultrasound in children with shock.Methods Children who were diagnosed shock in the PICU of Shengjing Hospital of China Medical University from May 1,2019 to April 31,2020 were included in this study.Rapid ultrasound in shock(RUSH)exam was used to evaluate the morphology and function of heart,lung and abdomen of children with shock,so as to assist the diagnosis and treatment of shock.Results Twenty-six children with shock were evaluated immediately according to the RUSH exam when they were admitted to hospital.Eight cases were diagnosed as septic shock,six cases as cardiogenic shock,six cases as hypovolemic shock and six cases as mixed shock.The left ventricular ejection fraction(LVEF)of children with cardiogenic shock was(26.5±8.24)%,and the width of inferior vena cava was greater than 10 mm.After the shock was corrected,LVEF increased to(32.17±26.11)%.However,the LVEF of children with septic shock was(73.25±1.28)%at admission and(50.12±31.41)%at shock correction.Nine cases(34.6%)found more B-lines in the lungs after fluid resuscitation for one hour in 26 children with shock.Among them,about 50%of the children with cardiogenic shock found more B-lines in their lungs one hour after fluid resuscitation,and 11 cases(57.9%)of the surviving children showed more B-lines after shock correction,but only six children could hear blisters after physical examination.Conclusion According to RUSH exam,we can evaluate the volume status,cardiac function,volume responsiveness and focus on infection in children with shock,distinguish the type of shock earlier and more accurately,assist in guiding fluid resuscitation,and facilitate accurate and individualized fluid management and treatment of patients.

关 键 词：休克 重症超声 休克患者快速超声评估方案 左室射血分数 B线 

分 类 号：R445.1[医药卫生—影像医学与核医学] R720.597[医药卫生—诊断学]