脓毒性休克新生儿无创血流动力学参数的变化特征  

Characteristics of changes in non-invasive hemodynamic parameters in neonates with septic shock

作　　者：房晓祎 谢锦芝 张霭润 李管明 杨斯岚[2] 黄晓玲[2] 郭继忠[2] 林霓阳[2] Fang Xiaoyi;Xie Jinzhi;Zhang Airun;Li Guanming;Yang Silan;Huang Xiaoling;Guo Jizhong;Lin Niyang(Department of Neonatology,the Seventh Affiliated Hospital,Sun Yat-sen University,Shenzhen 518107,Guangdong,China;Department of Neonatology,the First Affiliated Hospital,Shantou University Medical College,Shantou 515000,Guangdong,China)

机构地区：[1]中山大学附属第七医院新生儿科,广东深圳518107 [2]汕头大学医学院第一附属医院新生儿科,广东汕头515000

出　　处：《中华危重病急救医学》2025年第1期29-35,共7页Chinese Critical Care Medicine

基　　金：广东省深圳市科技计划项目(JCYJ20190809145409829)。

摘　　要：目的观察脓毒性休克新生儿无创血流动力学参数的变化特征,为临床诊疗提供依据。方法采用观察性研究方法,选择2017年9月至2023年11月汕头大学医学院第一附属医院新生儿重症监护病房(NICU)收治的脓毒性休克和脓毒症无休克新生儿作为研究对象,并依据胎龄分为早产儿(<37周)和足月儿(≥37周);同时选择同期产科出生的健康足月儿及出生后转入NICU的血流动力学稳定的早产儿作为对照。脓毒性休克组于治疗前、脓毒症无休克组于诊断脓毒症时、对照组于产科随母出院前或转入NICU当天,采用电子心力测量法(EC)检测血流动力学参数,包括心率(HR)、平均动脉压(MAP)、每搏量(SV)、每搏量指数(SVI)、心排血量(CO)、心排血指数(CI)、外周血管阻力(SVR)和外周血管阻力指数(SVRI)。结果最终纳入资料完整且家长同意进行无创血流动力学检测的新生儿113例,其中脓毒性休克组32例,脓毒症无休克组25例,对照组56例。脓毒性休克组代偿期17例,失代偿期15例;足月儿21例(20例治愈好转、1例死亡),早产儿11例(7例治愈好转、4例死亡),病死率为15.62%(5/32)。脓毒症无休克组足月儿18例,早产儿7例,均治愈好转,无死亡。对照组足月儿28例,出生后转入NICU早产儿28例。无创血流动力学参数分析显示,脓毒性休克组足月儿SV、SVI、CO、CI均较脓毒症无休克组和对照组显著下降〔SV(mL):3.52±0.99比5.79±1.32、5.22±1.02,SVI(mL/m^(2)):16.80(15.05,19.65)比27.00(22.00,32.00)、27.00(23.00,29.75),CO(L/min):0.52±0.17比0.80±0.14、0.72±0.12,CI(mL·s^(-1)·m^(-2)):40.00(36.67,49.18)比62.51(56.34,70.85)、60.01(53.34,69.68),均P<0.05〕,SVR、SVRI均较脓毒症无休克组和对照组显著升高〔SVR(kPa·s·L^(-1)):773.46±291.96比524.17±84.76、549.38±72.36,SVRI(kPa·s·L^(-1)·m^(-2)):149.27±51.76比108.12±12.66、107.81±11.87,均P<0.05〕;脓毒性休克组早产儿MAP、SV、SVI、CO、CI均较对照组显著�Objective To observe the characteristics of changes in non-invasive hemodynamic parameters in neonates with septic shock so as to provide clinical reference for diagnosis and treatment.MethodsA observational study was conducted.The neonates with sepsis complicated with septic shock or not admitted to neonatal intensive care unit(NICU)of the First Affiliated Hospital of Shantou University Medical College were enrolled as the study subjects,who were divided into preterm infant(<37 weeks)and full-term infant(≥37 weeks)according to the gestational age.Healthy full-term infants and hemodynamically stable preterm infants transferring to NICU after birth were enrolled as controls.Electronic cardiometry(EC)was used to measure hemodynamic parameters,including heart rate(HR),mean arterial pressure(MAP),stroke volume(SV),stroke volume index(SVI),cardiac output(CO),cardiac index(CI),systemic vascular resistance(SVR)and systemic vascular resistance index(SVRI),before treatment in the septic shock group,at the time of diagnosis of sepsis in the sepsis without shock group,and before the discharge from the obstetric department or on the day of transferring to NICU in the control group.ResultsFinally,113 neonates with complete data and parental consent for non-invasive hemodynamic monitoring were enrolled,including 32 cases in the septic shock group,25 cases in the sepsis without shock group and 56 cases in the control group.In the septic shock group,there were 17 cases at the compensated stage and 15 cases at the decompensated stage.There were 21 full-term infants(20 cured or improved and 1 died)and 11 premature infants(7 cured or improved and 4 died),with the mortality of 15.62%(5/32).There were 18 full-term infants and 7 premature infants in the sepsis without shock group and all cured or improved without death.The control group included 28 full-term infants and 28 premature infants transferring to NICU after birth.Non-invasive hemodynamic parameter analysis showed that SV,SVI,CO and CI of full-term infants in the septic sho

关 键 词：脓毒性休克 脓毒症 血流动力学 无创 新生儿 

分 类 号：R722.1[医药卫生—儿科]