床旁超声参数在儿童脓毒性休克液体管理中的指导价值  

The value of bedside ultrasound parameters in guiding fluid management of septic shock in children

作　　者：刘帅 王泽熙 徐梅先[1] 岳燕科 曹利静[1] LIU Shuai;WANG Zexi;XU Meixian;YUE Yanke;CAO Lijing(No.1 Department of Critical Care Medicine,Hebei Children's Hospital,Shijiazhuang Hebei 050031,China)

机构地区：[1]河北省儿童医院重症医学一科,河北石家庄050031 [2]河北省儿童医院神经康复科,河北石家庄050031

出　　处：《中国急救复苏与灾害医学杂志》2024年第6期796-800,819,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省2022年度医学科学研究重点课题计划指导性项目(编号:20220742)。

摘　　要：目的探讨床旁超声在儿童脓毒性休克液体管理中的指导价值,并分析其对患儿临床预后的评估价值。方法选取2021年10月—2023年2月河北省儿童医院收治的60例脓毒性休克患儿,依据治疗方案分为两组,各30例。对照组予以目标导向的液体复苏治疗,观察组在对照组基础上予以床旁超声监测。比较两组不同时间血流动力学指标[心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)]、床旁超声参数、组织灌注指标、乳酸、乳酸清除率、高迁移率族蛋白1(HMGB1)/白细胞介素(IL)-23/IL-17炎症轴、累计输液量、尿量、液体正平衡量等差异,并统计两组患者治疗28 d内病死率情况。结果观察组血管活性药物使用时间及剂量、机械通气时间、ICU入住时间及总住院时间少于对照组(均P<0.05);治疗6 h、12 h、24 h后两组HR、下腔静脉内径呼吸变异度明显下降,MAP及CVP、下腔静脉内径最大径、最小径及每搏输出量明显升高(P<0.05),但两组组间比较,差异无统计学意义(P>0.05);观察组治疗6 h、12 h、24 h HR、Pv-aCO_(2)低于对照组(均P<0.05);观察组治疗6 h、12 h、24 h乳酸低于对照组,乳酸清除率高于对照组(均P<0.05);观察组治疗6 h、12 h、24 h HMGB1、IL-23、IL-17水平低于对照组(均P<0.05);观察组治疗12 h、24 h液体正平衡量、累计输液量低于对照组,尿液高于对照组(均P<0.05);两组28 d病死率比较,差异无统计学意义(P>0.05)。结论床旁超声在儿童脓毒性休克液体管理方面具有一定指导价值,可改善患儿组织灌注指标,并降低减轻炎症反应,缩短患儿住院时间,有助于患儿病情缓解。Objective To investigate the guiding value of bedside ultrasound in fluid management of septic shock in children and its influence on clinical prognosis.Methods A total of 60 children with septic shock in our hospital from October 2021 to February 2023 were selected and divided into two groups according to treatment plan,with 30 cases in each group.The control group received targeted liquid resuscitation treatment,and the observation group received bedside ultrasound monitoring on the basis of the control group.Compare the hemodynamic parameters,bedside ultrasound parameters[heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP)],tissue perfusion parameters,lactate,lactate clearance rate,high mobility group protein-1(HMGB1)/interleukin-23/IL-17 inflammatory axis,cumulative infusion volume,urine volume,and positive fluid balance between two groups at different times,and calculate the mortality rate of the two groups of patients within 28 days of treatment.Results The use time and dosage of vasoactive drugs,mechanical ventilation time,ICU stay time,and total hospitalization time in the observation group were less than those in the control group(all P<0.05).After 6,12,and 24 hours of treatment,the HR and respiratory variability of the inferior vena cava diameter decreased significantly in the two groups,while MAP and CVP,the maximum and minimum diameters of the inferior vena cava diameter,and the output per stroke increased significantly(P<0.05).However,there was no statistically significant difference between the two groups(P>0.05);the HR and Pv-aCO_(2) levels in the observation group were lower than those in the control group at 6,12,and 24 hours of treatment(all P<0.05);the observation group had lower lactate levels and higher lactate clearance rates than the control group at 6,12,and 24 hours of treatment(all P<0.05);the levels of HMGB1,IL-23 and IL-17 in observation group were lower than those in control group at 6 hours,12 hours and 24 h after treatment(all P<0.05);the accumulative infusion vo

关 键 词：儿童 床旁超声 脓毒性休克 液体管理 指导价值 预后 

分 类 号：R631[医药卫生—外科学] R445.1[医药卫生—临床医学]