去甲肾上腺素治疗新生儿脓毒性休克疗效研究  

Efficacy of norepinephrine in the treatment of neonatal septic shock:an observation study

作　　者：张静[1] 钟隽镌 莫镜[1] 马冬菊 林颖仪 王越[1] 帅春[1] 叶秀桢[1] Zhang Jing;Zhong Junjuan;Mo Jing;Ma Dongju;Lin Yingyi;Wang Yue;Shuai Chun;Ye Xiuzhen(Department of Neonatology,Guangdong Women and Children's Hospital,Guangzhou 511400,China)

机构地区：[1]广东省妇幼保健院新生儿科,广州511400

出　　处：《中华新生儿科杂志（中英文）》2022年第2期133-137,共5页Chinese Journal of Neonatology

基　　金：广州市科技计划项目(202102080378)。

摘　　要：目的探讨去甲肾上腺素在脓毒性休克新生儿救治中的疗效及安全性。方法选择2019年1月至2020年11月广东省妇幼保健院新生儿重症监护病房收治的脓毒性休克并使用去甲肾上腺素治疗的患儿进行前瞻性研究,入选患儿均在去甲肾上腺素治疗前及治疗后1 h应用功能性超声心动图进行血流动力学监测,并同时记录血压、心率、血气分析结果;记录诊断休克至开始去甲肾上腺素治疗期间(T0)及治疗开始后24 h(T1)的液体入量及尿量,分析患儿血流动力学参数、血管活性药物使用、液体超负荷及临床转归情况。结果共纳入66例患儿,其中轻度休克27例,中度休克33例,重度休克6例,男婴48例,早产儿38例,胎龄(35.2±4.1)周,出生体重(2476±909)g;休克诊断时间中位数为生后2 d,休克评分中位数4分。开始去甲肾上腺素治疗时间中位数为诊断休克后7.5 h;与接受去甲肾上腺素治疗前相比,治疗后1 h的每搏输出量、每搏输出量指数、心输出量、心脏指数、左室射血分数、缩短分数、收缩压、舒张压、平均动脉压及血pH、BE均明显升高,心率和中-重度休克组血乳酸明显下降,治疗后24 h尿量明显增多,液体超负荷明显降低,差异有统计学意义(P<0.05)。越早开始去甲肾上腺素治疗,休克病程中所需的多巴胺最大剂量越低(r=0.325,P=0.008)、血管活性药物下调时间越早(r=0.383,P=0.003)、使用时间越短(r=0.319,P=0.015)。66例患儿中,58例休克纠正,14例28 d内死亡。结论去甲肾上腺素对于脓毒性休克新生儿治疗是有效、可行的,可明显改善血流动力学参数。Objective To study the efficacy of norepinephrine in the treatment of neonates with septic shock.Methods A prospective observation study of neonates with septic shock,who received norepinephrine in the neonatal intensive care unit of Guangdong Women and Children's Hospital from January 2019 to November 2020.All infants had functional echocardiography for hemodynamic monitoring before norepinephrine treatment and 1 hour thereafter blood pressure,heart rate,arterial blood gas analyses were recorded at the same time.The intravenous fluid volume and urine volume from the diagnosis of shock to the commencement of norepinephrine therapy(T0)and 24 hours thereafter(T1)were recorded,and the hemodynamic parameters,vasoactive drugs and clinical outcomes were analyzed.Results A total of 66 newborns were enrolled,including 27 cases of mild shock,33 cases of moderate shock and 6 cases of severe shock.48 were male infants,38 cases were premature infants.The gestational age was(35.2±4.1)weeks and the birth weight was(2476±909)g.The median time of shock diagnosis was 2 days after birth,and the median shock score was 4 points.The median time from the diagnosis of shock to the start of norepinephrine treatment was 7.5 hours.Compared with that before norepinephrine treatment,stroke volume,stroke volume index,cardiac output,cardiac index,left ventricular ejection fraction,shortening fraction,systolic blood pressure,diastolic blood pressure,mean arterial pressure,blood pH and BE at 1 hour after treatment were increased,heart rate and blood lactic acid were decreased,the differences were statistically significant(P<0.05).Urine volume was increased 24 hours after treatment(P<0.05),and fluid overload decreased(P<0.05).The maximum dopamine dose,the down-regulation time and duration of vasoactive drugs were positively correlated with the time to start norepinephrine therapy(r=0.325、r=0.383、r=0.319,P<0.05).Among the 66 infants,58 infants with shock had been corrected and 14 infants died within 28 days.Conclusions Norepinephrine is eff

关 键 词：脓毒性休克 超声心动图 去甲肾上腺素 血流动力学 婴儿 新生 

分 类 号：R720.597[医药卫生—急诊医学]