重症超声指导儿童脓毒性休克液体复苏的临床意义

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。

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

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.