Dopamine clearance in critically ill patients

Objective: To examine the validity of the low-dose “renal” dopamine regimen in critically ill patients by investigating the steady-state clearance of dopamine. Design: A prospective clinical study. Setting: Teaching hospital intensive care unit. Patients: 48 haemodynamically stable patients receiving a dopamine infusion. Interventions: Sampling of arterial blood and dopamine infusates. Measurement and results: Plasma and infusate dopamine levels were measured by liquid chromatography with electrochemical detection. Steady-state clearance was determined by dividing the actual infusion rate by the steady-state plasma concentration. Dopamine clearance for the whole group was 46.4 ± 35.9 ml/kg per min (mean ± SD), which is significantly lower than 70 ± 15.2 ml/kg per min reported for elective surgical patients (p = 0.01). Twelve patients with renal dysfunction had significantly lower dopamine clearances (36 ± 16.6 ml/kg per min) than the remaining 36 patients (61 ± 38.5 ml/kg per min, p = 0.022). There was a very poor correlation between plasma dopamine level and infusion rate for the group as a whole (r = 0.47), and this worsened (r = 0.31)when only those patients on a “renal” dose of 2–5 μg/kg per min were considered (n = 30). Conclusion: Plasma dopamine clearance is lower in critically ill patients and there is a large interindividual variation. It is therefore impossible to predict the plasma level from the infusion rate. Consequently, the concept of a selective renovascular low-dose dopamine infusion is invalid in critically ill patients. Received: 12 January 1998 Accepted: 15 July 1998     

Early hyperlactataemia in critically ill children

Objective: To examine the relationships between early hyperlactataemia, acidosis, organ failure, and mortality in children admitted to intensive care.¶Design: Prospective observational study. Children with lactate levels > 2 mmol/l were eligible for enrolment. Post-operative patients and those with inherited metabolic disease were excluded. Seven hundred and five children admitted to intensive care were screened, and 50 children with hyperlactataemia (incidence 7 %), aged 20.3 months (0.1–191) were enrolled and followed up. The Paediatric Risk of Mortality (PRISM) score, Multiorgan System Failure (MOSF) score, length of ICU stay, and outcome were recorded. Data were collected for lactate (mmol/l), pH, and base excess (BE) until 24 h after admission. Data are reported as median (range) and were analysed by the Mann-Whitney, Fisher's Exact, and Kruskal-Wallis tests, and chi-squared test for trend.¶Results: Overall mortality in the screening group was 70/705 (10 %). In the study group (n = 50) median PRISM score was 19 (4–49), median MOSF score 2 (1–4), and observed mortality 32/50 (64 %). Median duration of ICU stay was 6 days (2–32) in survivors, and median time until death 3 days (0–13) in nonsurvivors. Eleven nonsurvivors (34 %) died within 24 h. In the screening group, hyperlactataemia on admission identified mortality with likelihood ratio = 15. In the study group, neither the admission lactate (3.8 vs 4.6 mmol/l, P = 0.27), pH (7.32 vs 7.30, P = 0.6), nor BE (–7.5 vs –8, P = 0.45) differed significantly between survivors and nonsurvivors. Neither the admission nor peak lactate increased with increasing MOSF score (P = 0.5 and 0.54). The median peak lactate level was 5 mmol/l (2–9.3) in survivors compared to 6.8 mmol/l (2.3–22) in nonsurvivors (P = 0.02), and the cumulative average lactate level was 2.4 mmol/l (1–4.9) in survivors, compared to 4.5 mmol/l (1.6–21) in nonsurvivors (P = 0.0003). Persistent hyperlactataemia 24 h after admission identified mortality with likelihood ratio = 7.¶Conclusion: Hyperlactataemia on admission to intensive care is associated with a high mortality in children. Nonsurvivors within this group may be distinguished by the peak lactate level, or by persistent hyperlactataemia after 24 h of treatment.     

Pulse oximetry in critically ill children

To confirm the clinical applicability of a commercial pulse oximeter, we compared arterial hemoglobin saturation values determined by in-vitro oximetry and pulse oximetry in 15 critically ill children. One hundred ninety-two paired hemoglobin saturations were determined by both noninvasive pulse oximetry and direct measurement ot arterial blood samples. The correlation between these two methods of measurement was statistically significant (r = 0.895;p < 0.001). The mean percentage difference between the two measurements was 1.8%. Pulse oximetry was found to be safe and less cumbersome than other methods of monitoring arterial oxygen content. Overall, pulse oximetry was precise and provided a clinically satisfactory noninvasive method tor continuously monitoring arterial hemoglobin saturation in critically ill children.     

危重症患儿甲状腺功能测定及其意义

为进一步研究危重症患儿垂体甲状腺功能与疾病预后关系，检测３１例重危症患儿血清甲状腺激素水平并与２０例健康儿童作对照观察。结果：重危症患儿低三碘甲腺原氨酸（Ｔ３）和（或）低甲状腺素（Ｔ４）者２８例（８７．５％），以低Ｔ３发生率最高。６例出现低Ｔ３伴低Ｔ４者中有５例死亡。重危症患儿死亡组Ｔ４（３８．１４±８．４８ｎｍｏｌ／Ｌ）明显低于存活组（８２．５５±３７．８６ｎｍｏｌ／Ｌ）。认为：检测重危患儿血清甲状腺激素对正确判断甲状腺功能及估计疾病预后有一定价值     

Arterial thromboembolic complications in critically ill children

PURPOSE: To evaluate incidence and characteristics of arterial thromboembolic complications in critically ill children. MATERIALS AND METHODS: Hospital records of all consecutive patients with arterial thromboembolic events (ATEs) occurring in the pediatric intensive care unit (PICU) from January 1997 to August 2001 were reviewed. Data collected included demographics and location, treatment modalities and outcome of ATEs. RESULTS: Fifty-four ATEs in 51 children (median age, 14 days) were identified, reflecting an incidence of 1.2% of all PICU patients. Arterial thromboembolic events were located in peripheral arteries in 52 (96%) cases and were associated with indwelling arterial catheters (n=26) or cardiac catheterization (n=26). The remaining 2 ATEs were located in the left ventricle and cerebral arteries, respectively. Therapy consisted of heparin (n=51), thrombolysis (n=22), oral anticoagulation (n=12), and aspirin (n=34). Complete resolution was noted in 33 (70%), partial resolution in 10 (21%), and no resolution in 4 (8.5%) cases. Bleeding complications occurred in 1 patient treated with heparin and in 12 (54%) of the 22 patients receiving thrombolytic therapy. CONCLUSIONS: Arterial thromboembolic events are frequent complications of PICU, particularly affecting neonates, and mostly associated with catheters. Studies to determine safe and effective prophylactic and treatment modalities of ATEs in children are required.     

A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients

Introduction

The Risk, Injury, Failure, Loss, and End-Stage Renal Disease (RIFLE) is a consensus-based classification system for diagnosing acute kidney insufficiency (AKI), based on serum creatinine (SCr) and urine output criteria (RIFLE_SCr+UO). The urine output criteria, however, are frequently discarded and many studies in the literature applied only the SCr criteria (RIFLE_SCr). We diagnosed AKI using both RIFLE methods and compared the effects on time to AKI diagnosis, AKI incidence and AKI severity.

Methods

This was a prospective observational cohort study during four months in adult critically ill patients admitted to the ICU for at least 48 hours. During the first week patients were scored daily for AKI according to RIFLE_SCr+UO and RIFLE_SCr. We assessed urine output hourly and fluid balance daily. The baseline SCr was estimated if a recent pre-ICU admission SCr was unknown. Based on the two RIFLE methods for each patient we determined time to AKI diagnosis (AKI-0) and maximum RIFLE grade.

Results

We studied 260 patients. A pre-ICU admission SCr was available in 101 (39%) patients. The two RIFLE methods resulted in statistically significantly different outcomes for incidence of AKI, diagnosis of AKI for individual patients, distribution of AKI-0 and distribution of the maximum RIFLE grade. Discarding the RIFLE urine criteria for AKI diagnosis significantly underestimated the presence and grade of AKI on admission and during the first ICU week (P < 0,001) and significantly delayed the diagnosis of AKI (P < 0.001). Based on RIFLE_SCr 45 patients had no AKI on admission but subsequently developed AKI. In 24 of these patients (53%) AKI would have been diagnosed at least one day earlier if the RIFLE urine criteria had been applied. Mortality rate in the AKI population was 38% based on RIFLE_SCr and 24% based on RIFLE_SCr+UO (P = 0.02).

Conclusions

The use of RIFLE without the urine criteria significantly underscores the incidence and grade of AKI, significantly delays the diagnosis of AKI and is associated with higher mortality.     

危重症患儿血浆纤维连接蛋白含量变化及其意义

探讨危重症患儿血浆纤维连接蛋白（Ｆｎ）的变化特点及其意义。测定７５名危重患儿Ｆｎ含量。结果显示：其值（１６０．４２±７８．１８ｍｇ／Ｌ）明显下降，与正常儿童的Ｆｎ含量（２５９．３０±３４．６８ｍｇ／Ｌ）相比有显著性差异（ｔ＝５．１１１，Ｐ＜０．０１）；呼吸衰竭、全身感染和中枢神经系统疾病时Ｆｎ均有降低；另外，２２例门诊或中度呼吸道感染的患儿Ｆｎ与正常儿童相比无显著性差异（ｔ＝１．８７１，Ｐ＞０．０５），而与危重症患儿相比差异有显著性（ｔ＝５．４０９，Ｐ＜０．０１）；严重呼吸衰竭需机械通气患儿Ｆｎ含量比呼吸衰竭不需机械通气患儿Ｆｎ降低更明显；而感染性休克患儿Ｆｎ比未合并休克患儿的Ｆｎ减低更明显。所以，小儿危重症时Ｆｎ降低主要与疾病的严重程度有关，Ｆｎ若持续降低，则提示预后不良，Ｆｎ可作为判定疾病严重程度和病情转归的指标之一，也可作为临床Ｆｎ替代治疗的一个指征     

Pharmacokinetics and pharmacodynamics of dopamine and norepinephrine in critically ill head-injured patients

Objective To explore the pharmacokinetics and pharmacodynamics of dopamine and norepinephrine.Design Prospective, controlled, trial.Setting Neurosciences critical care unit.Patients Eight patients with a head injury, requiring dopamine or norepinephrine infusions to support cerebral perfusion pressure (CPP).Intervention Patients received in randomised order, either dopamine or norepinephrine to achieve and maintain a CPP of 70 mmHg, and then, following a 30-min period of stable haemodynamics, a CPP of 90 mmHg. Data were then acquired using the second agent. Haemodynamic measurements were made during each period and a blood sample was obtained at the end of each study period for analysis of plasma catecholamine concentrationsMeasurements and results Plasma levels of norepinephrine and dopamine were significantly related to infusion rates but did not have a simple linear relationship to haemodynamic parameters. However, there was a significant quadratic relationship between the infusion rate of dopamine and cardiac index (r ²=0.431), and systemic vascular resistance index (r ²=0.605), with a breakpoint (at which cardiac index reduced and SVRI increased) at a dopamine plasma level of ~ 50 nM/l (corresponding to an infusion rate of ~ 15 g·kg^-1·min^-1).Conclusions Norepinephrine and dopamine have predictable pharmacokinetics; however, those of dopamine do not fit a simple first-order kinetic model. The pharmacodynamic effects of dopamine and norepinephrine show much inter-individual variability and unpredictability. Plasma levels of dopamine appear to relate to variations in adrenergic receptor effects with break points that reflect expectations from infusion-rate related pharmacodynamics.     

危重症患儿肠内营养研究进展

文章归纳了危重症患儿肠内营养治疗时的关键问题,指出了危重症患儿需早期开展肠内营养,减少肠内营养治疗的中断,并对肠内营养实施的途径及输注方式的研究进展进行了综述。     

Parenteral glutamine increases serum heat shock protein 70 in critically ill patients

Objective Heat shock protein 70 (HSP-70) is protective against cellular and tissue injury. Increased serum HSP-70 levels are associated with decreased mortality in trauma patients. Glutamine (Gln) administration increases serum and tissue HSP-70 expression in experimental models of sepsis. Gln has been safely administered to critically ill patients and can improve clinical outcomes, but the effect of Gln administration on HSP-70 expression in humans is unknown. We examined whether Gln-supplemented parenteral nutrition (PN) increases serum HSP-70 levels in critically ill patients.Design and setting Randomized, controlled, double-blind study in surgical intensive care units (SICU) in a university hospital.Patients 29 patients admitted to the SICU and requiring PN for more than 7 days.Interventions Patients received either Gln-PN (containing alanyl-glutamine dipeptide; 0.5 g/kg per day; n=15) or standard Gln-free PN (control-PN) that was iso-nitrogenous to Gln-PN (n=14). Serum HSP-70 concentrations were measured at enrollment and at 7 days. Clinical outcome measures were also determined.Results HSP-70 concentrations were unchanged in control-PN subjects from baseline to day 7. In marked contrast, Gln-PN subjects demonstrated significantly higher (3.7-fold) serum HSP-70 concentrations than control subjects. In Gln-PN patients there was a significant correlation between increases in HSP-70 levels over baseline and decrease in ICU length of stay.Conclusions Gln-PN significantly increases serum HSP-70 in critically ill patients. The magnitude of HSP-70 enhancement in Gln-treated patients was correlated with improved clinical outcomes. These data indicate the need for larger, randomized trials of the Gln effect on serum and tissue HSP-70 expression in critical illness and relationship to clinical outcomes.     

Oxygen uptake and carbon dioxide elimination after acetazolamide in the critically ill

Acetazolamide, which reversibly inhibits carbonic anhydrase, is a useful diuretic in alkalotic and over-hydrated patients. In two earlier investigations we have consistently found increases in the arterial and venous oxygen saturation and tension when patients were treated with acetazolamide 15 mg·kg^-1. A plausible explanation of this phenomenon is that acetazolamide diminishes oxygen consumption. In the present study we measured oxygen uptake in 10 critically ill patients. We found a minor and statistically insignificant decrease in oxygen consumption. Nevertheless SvO₂ increased from 0.77 to 0.83 and PvO₂ from 5.9 kPa to 6.8 kPa. It is still not possible from this investigation to determine the origin of the improvement in blood oxygenation. The inhibition of carbonic anhydrase caused a CO₂ retention of 5.8% of the total CO₂ production. An increase in body stores of CO₂ of this magnitude is without clinical significance.     

Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients

Objective: We studied the agreement between cardiac output measurements via pulmonary artery thermodilution [CO(PA)], regarded as the current clinical gold standard, and aortic transpulmonary thermodilution [CO(AORTA)]. Design: Prospective clinical study. Setting: Surgical intensive care unit of a university hospital. Patients: 37 patients with sepsis or septic shock (n = 34) and subarachnoid haemorrhage (n = 3). Measurements and results: We analysed 449 simultaneous cardiac output measurements. All patients were deeply sedated and mechanically ventilated in a pressure controlled mode. Each patient received a 7.5-F five-lumen pulmonary artery catheter and a 4-F aortic catheter with an integrated thermistor. The thermistors of the two different catheters were connected to one computer system (COLD-Z021, Pulsion Medical Systems, Munich, Germany). Linear regression analysis revealed: CO(AORTA) = 0.96 · CO(PA) + 1.02 (l/min) (r = 0.97, p < 0.0001). CO(AORTA) was consistently higher than CO(PA) with a bias of 0.68 (l/min) and a standard deviation of 0.62 (l/min). Conclusion: Cardiac output derived from aortic transpulmonary thermodilution is suitable for measurement in the intensive care unit. Measurements of CO(AORTA) are consistent with, but slightly higher than, those obtained from pulmonary artery thermodilution. Received: 8 February 1999 Final revision received: 26 May 1999 Accepted: 28 May 1999     

An evaluation of enteral feeding practices in critically ill children

Background: Establishing and sustaining enteral feeding in critically ill children is challenging and has met with many problems. Aims and objectives: The aim of this study was to investigate (a) how actual calorie intake compared with estimated caloric requirements and (b) whether feeding guideline adherence resulted in improved nutritional intake. Design and methods: A prospective observational study was undertaken over 1 month in a tertiary referral paediatric intensive care unit (PICU) in the northwest of England. Results: Forty‐seven children were studied, with a wide range of diagnoses in a 1‐month period. Only 47% of the children had enteral feeds started within our 6 h post‐admission target. Over half (55%) of the children received less than half of their estimated calorie requirements, but if feeding guidelines were followed, this resulted in a significantly higher (p = 0·004) delivery of the child's estimated requirements. Conclusions: This study found that many children are not receiving adequate nutrition in PICU and that the use of feeding guidelines significantly improves calorie delivery in PICU patients. Relevance to clinical practice: This paper highlights the dearth of research related to enteral feeding in critically ill children. We found that the use of feeding guidelines improved calorie delivery and so units should be encouraged to develop their own guidelines based on the best evidence available.     

Consensus guidelines on sedation and analgesia in critically ill children

Objective The United Kingdom Paediatric Intensive Care Society Sedation, Analgesia and Neuromuscular Blockade Working Group is a multi-disciplinary expert panel created to produce consensus guidelines on sedation and analgesia in critically ill children and forward knowledge in these areas. Sedation and analgesia are recognised as important areas of critical care practice and adult clinical practice guidelines in these fields remain amongst the most popular of those produced by the Society of Critical Care Medicine. However, similar clinical practice guidelines have not previously been produced for the critically ill paediatric patient.Design A modified Delphi technique was used to allow the Working Group to anonymously consider draft recommendations in three Delphi rounds with predetermined levels of agreement. This process was supported by a total of four consensus conferences. Once consensus had been reached, a systematic review of the available literature was carried out.Outcome A set of consensus guidelines was produced including 20 key recommendations, 10 relating to the provision of analgesia and 10 relating to the sedation of critically ill children. An evaluation of the existing literature supporting these recommendations is provided.Conclusions Multi-disciplinary consensus guidelines for maintenance sedation and analgesia in critically ill children have been successfully produced and are supported by levels of evidence (excluding sedation and analgesia for procedures and excluding neonates). The working group has highlighted the paucity of high-quality evidence in these important clinical areas and this emphasises the need for further randomised clinical trials in this area.This article is discussed in the editorial available at: Financial support received: none.Conflict of interest: none.     

危重症患儿早期运动锻炼的研究进展

综述危重症患儿早期运动锻炼的类型、开始时间、评估内容、运动方案、运动防护、终止标准及干预效果,旨在为国内危重患儿开展早期运动锻炼提供借鉴。     

Pilot safety study of low-dose vasopressin in non-septic critically ill children

Objective  To assess the safety of low-dose vasopressin infusion in critically ill children requiring prolonged mechanical ventilation (MV) at risk of developing sedation/analgesia-related hypotension. Method  Randomized pilot safety study in children expected to require MV for at least 3 days. Children received either vasopressin (0.0005 U/kg/min) or sodium chloride (0.9%) infusion for a period of 48 h. Haemodynamic variables, urine output and serum electrolytes were closely monitored and analyzed. Results  Twelve children in each group had similar baseline characteristics. Vasopressin infusion was associated with an 8 mmol/L fall in serum sodium concentration (p < 0.01) and with higher incidence of hyponatraemia (8 vs. 66%, p < 0.01). In normotensive children, low-dose vasopressin also induced a reversible decrease in urine output, and acutely increased blood pressure (p < 0.01). After stopping the vasopressin there was rebound hypotension (p < 0.01). Conclusion  Low-dose vasopressin infusion in haemodynamically stable, but critically ill, children is associated with reduction in urine output and decreased serum sodium level, yielding a high incidence of hyponatraemia. We conclude that these effects limit further study of prophylactic vasopressin for sedation-related hypotension in a randomized controlled trial.     

Early predictors of post-hospital adjustment problems in critically ill young children

Toddlers and preschool children have been identified as being at risk for post-hospital behavioral sequelae, especially when confronted with an unanticipated intensive care unit (ICU) hospitalization. The purpose of this predictive secondary analysis was to determine demographic and clinical variables that could be assessed early during hospitalization to predict internalizing and externalizing behaviors and negative behavioral change of 2- to 7-year-old children at 3 and 6 months following an unanticipated critical care hospitalization (n = 163 mother-child dyads). The children's behavioral predilections prior to hospitalization (i.e., internalizing or externalizing behaviors) and sex, as well as elevated maternal state anxiety, marital status, and level of emotional care giving by mothers, significantly predicted child internalizing and externalizing behavior and post-hospitalization behavior changes. Results suggest several risk factors that predispose children to poor outcomes following an unanticipated hospitalization that could be targeted for intervention to improve children's emotional and behavioral health.     

Clinical and pathologic characteristics of pancreatic necrosis in critically ill children

BACKGROUND: Pancreatic damage in critically ill patients is associated with the progressive failure of multiple organs, but little is known about its clinical characteristics. At present, no guidelines are available for the diagnosis and management of pancreatic damage. This study was undertaken to analyze the clinical and pathologic characteristics of pancreatic necrosis in critically ill children, and to find some biological markers of pancreatic damage or pancreatic necrosis.METHODS: We retrospectively reviewed the clinical data, laboratory results, and autopsy findings of 25 children, who were admitted to Hunan Children’s Hospital, China from 2003 to 2009, and died of multiple organ failure. The autopsy revealed pancreatic necrosis in 5 children, in whom sectional or gross autopsy was performed.RESULTS: The 5 children had acute onset and a fever. Two children had abdominal pain and 2 had abdominal bulging, flatulence and gastrointestinal bleeding. Four children had abnormal liver function, characterized by decreased albumin and 3 children had elevated level of C-reactive protein (CRP). B-ultrasonography revealed abnormal acoustic image of the pancreas in all children, and autopsy confirmed pancreatic necrosis, which may be associated with the damage of the adrenal gland, liver, lung, heart, spleen, kidney, intestine, thymus, mediastinal and mesenteric lymph nodes and other organs. Children 1 and 2 died of acute hemorrhagic necrotizing pancreatitis (AHNP); children 3-5 died of multiple organ dysfunction syndrome (MODS) due to pancreatic necrosis.CONCLUSION: Pancreatic damage or pancreatic necrosis in critically ill children is characterized by acute onset, severity, short course, multiple organ damage or failure. It may be asymptomatic in early stage, and easy to be ignored.     

儿科急诊危重患儿状况调查及分析

目的 调查分析儿科急诊危重患者状况,以期对诊治提出改进意见.方法 入急诊监护室374例危重患儿,记录来院方式、途中治疗、急诊停留时间,检测血气、生化,评估小儿/新生儿危重病例评分(PCIS/NCIS)、格拉斯哥昏迷评分(GCS),判断是否符合全身炎症反应综合征(SIRS)、脓毒症、感染性休克.结果 在374例患儿中,新生儿占29.9％,其余患儿平均年龄37.4个月.急诊停留时间4.7 h (0.42～96 h),感染性疾病47.6％.出租车、救护车、私家车为主要来院工具,分别占38.3％、28.4％、21.5％.病死率12.3％,住院病死率10.3％,急诊病死率15.6％,差异具有统计学意义(P＜0.01).PCIS/NCIS评分(81.92±9.66),危重评分≤80占44.4％、≤90占81％.172例患儿接受GCS评估,GCS≤8、9～12、13～15分别占35.5％、21.5％、43.0％.病死率为26.23％、10.81％、5.41％,差异具有统计学意义(P＜0.01).GCS≤8与13～15、GCS 9～12与13～15患儿PCIS差异具有统计学意义(P＜0.01);GCS≤8与9～12间PCIS差异无统计学意义(P＞0.05).PCIS与GCS二者正相关(r=0.454,P=0.01),能建立直线回归(R2 =0.183,回归系数t检验P＜0.01).374例,SIRS 41.7％,脓毒症25.7％.262例非新生儿病例,休克占43.5％,61.4％为感染性休克.374例中,低血钠37.2％,高血钾22.0％.新生儿低血糖20.91％,高血糖29.1％;非新生儿低血糖9％,高血糖66.7％.pH ＜7.35的酸中毒67.8％,pH＜7.2的严重酸中毒33.1％.结论 (1)新生儿、婴幼儿占急诊危重患儿绝大部分;(2)急诊停留时间相对较短(4.7 h).急诊病死率高于住院病死率( 15.6％ vs.10.3％,P＜0.01),应积极缩短急诊停留时间,尽早住院;(3)不同交通工具来院,危重评分差异无统计学意义,使用救护车者不到1/3 (28.4％),应提高社会使用院前急救服务的意识并提高院前急救的便利性;(4)急诊PCIS/NCIS可有效评估病情与预后;重度脑功能障碍(GCS≤8)、中度脑功能障碍(GCS 8～12)共57％,非创伤性脑功能损伤在儿科急诊重患中占重要地位;(5) GCS≤8、9～12与13～15患儿的PCIS差异有统计学意义,GCS＜ 13应予重视,患儿可能处于危重状态;(6)SIRS 41.7％,脓毒症25.7％;休克占43.5％,感染性休克为主(61.4％),应重视急诊危重患儿循环、器官组织灌注状态观察与评估,以早期识别休克;(7)电解质紊乱以低血钠(37.2％)、高血钾(22.0％)最常见;高血糖(66.7％)常见,新生儿也应注意低血糖(20.91％);酸碱平衡紊乱以酸中毒为主(67.8％),应注意相关检测及监测.