小儿脓毒性休克的治疗探讨

目的探讨小儿脓毒性休克新推荐方案的治疗效果。方法收集采用传统方案治疗的脓毒性休克患儿82例(传统方案组)和采用新推荐方案治疗的脓毒性休克患儿59例(新推荐方案组),对两组的休克纠正率、病死率、急性呼吸窘迫综合征的治疗有效率进行比较。结果新推荐方案组采取早期多组生理盐水快速扩容使休克纠正率明显提高(30%vs86%,P<0.01);使用小剂量琥珀酸氢化可的松可使脓毒性休克患儿的病死率降低(50%vs32%,P<0.01);保护性肺通气策略有助于降低脓毒性休克合并急性呼吸窘迫综合征的病死率,但差异无显著性(70%vs32%,P>0.05);采用新推荐方案治疗后脓毒性休克患儿病死率明显降低(62%vs44%,P<0.01)。结论应用新推荐方案针对脓毒性休克患儿的不同时期和并发症及时恰当的治疗,可降低其病死率。

Study on the treatment of septic shock in children

Objective To explore the efficacy of the new recommended protocol for treatment of septic shock in children.Methods Two groups of subjects including 82 patients with pediatric septic shock who received traditional strategy(traditional group) and 59 patients with pediatric septic shock who received the new recommended strategy(recommended group) were recruited.The curative rate of shock,the effective rate of ARDS and the mortality rate were compared between the two groups.Results Curative rate of shock was significantly improved by using sodium chloride solution in early stage to extend blood capability rapidly according the new recommended protocol(30% vs 86%,P<0.01).The mortality rate was reduced by using low dose of hydrocortisone sodium succinate(50% vs 32%,P<0.01).The lung protective strategy was useful in decreasing the mortality rate of pediatric septic shock with ARDS(70% vs 32%,P>0.05).The mortality rate was lowered in the children with septic shock who received the new recommended strategy(62% vs 44%,P<0.01).Conclusion Suitable and immediate treatment guided by the new recommended protocol can reduce the mortality of septic shock in children.