目的 比较晶体液单用与加用白蛋白两种液体疗法在小儿脓毒性休克中的治疗作用.方法 采用回顾性研究方法,收集河北省儿童医院重症医学科收治的63例脓毒性休克患儿的临床资料,按照入院后1h内液体复苏治疗中是否给予白蛋白将患儿分为两组.观察组33例,于入院后30 min内输入生理盐水20 mL/kg后再给予白蛋白1 g/kg进行复苏治疗;对照组30例,入院后30 min内输入生理盐水20 mL/kg,并根据液体治疗的反应情况继续给予生理盐水扩容.其他抗感染及血管活性药物使用原则相同.比较两种方法治疗患儿的第一小时输液量、循环稳定时间、肺水肿发生率及达标后0、6、12h血乳酸水平,并计算血乳酸清除率.结果 观察组患儿第一小时输液量明显减少对照组(mL:41.56±10.50比57.24±7.54,t=4.596,P=0.000);达到循环稳定时间少于对照组,但差异无统计学意义(min:219.87±70.23比287.10±67.00,t=2.047,P=0.360);肺水肿发生率略低于对照组[6.1％(2/33)比10.0％(3/30),x2=2.272,P=0.259].两组随复苏时间延长,乳酸水平逐渐下降,乳酸清除率逐渐升高;在复苏后0h、6h,观察组乳酸水平(mmol/L)明显低于对照组[0 h:3.65 ±2.84比5.72±2.11,t=1.940,P=0.046;6 h:2.12±1.21比4.09±1.45,t=2.892,P=0.005],乳酸清除率较对照组明显升高[0 h:(0.38±0.15)％比(0.18±0.09)％,t=1.447,P=0.018;6 h:(0.62±0.14)％比(0.51±0.11)％,t=1.920,P=0.047];在复苏后12h,观察组与对照组间乳酸(mmol/L:1.46±0.39比1.54±1.90,t=0.450,P=0.072)及其清除率[(0.78±0.19)％比(0.77±0.18)％,t=0.091,P=0.928]差异均无统计学意义.结论 脓毒性休克患儿容量复苏时给予白蛋白,能使循环更早稳定,无肺水肿发生,提升难治性脓毒性休克抢救成功率.
目的 比較晶體液單用與加用白蛋白兩種液體療法在小兒膿毒性休剋中的治療作用.方法 採用迴顧性研究方法,收集河北省兒童醫院重癥醫學科收治的63例膿毒性休剋患兒的臨床資料,按照入院後1h內液體複囌治療中是否給予白蛋白將患兒分為兩組.觀察組33例,于入院後30 min內輸入生理鹽水20 mL/kg後再給予白蛋白1 g/kg進行複囌治療;對照組30例,入院後30 min內輸入生理鹽水20 mL/kg,併根據液體治療的反應情況繼續給予生理鹽水擴容.其他抗感染及血管活性藥物使用原則相同.比較兩種方法治療患兒的第一小時輸液量、循環穩定時間、肺水腫髮生率及達標後0、6、12h血乳痠水平,併計算血乳痠清除率.結果 觀察組患兒第一小時輸液量明顯減少對照組(mL:41.56±10.50比57.24±7.54,t=4.596,P=0.000);達到循環穩定時間少于對照組,但差異無統計學意義(min:219.87±70.23比287.10±67.00,t=2.047,P=0.360);肺水腫髮生率略低于對照組[6.1％(2/33)比10.0％(3/30),x2=2.272,P=0.259].兩組隨複囌時間延長,乳痠水平逐漸下降,乳痠清除率逐漸升高;在複囌後0h、6h,觀察組乳痠水平(mmol/L)明顯低于對照組[0 h:3.65 ±2.84比5.72±2.11,t=1.940,P=0.046;6 h:2.12±1.21比4.09±1.45,t=2.892,P=0.005],乳痠清除率較對照組明顯升高[0 h:(0.38±0.15)％比(0.18±0.09)％,t=1.447,P=0.018;6 h:(0.62±0.14)％比(0.51±0.11)％,t=1.920,P=0.047];在複囌後12h,觀察組與對照組間乳痠(mmol/L:1.46±0.39比1.54±1.90,t=0.450,P=0.072)及其清除率[(0.78±0.19)％比(0.77±0.18)％,t=0.091,P=0.928]差異均無統計學意義.結論 膿毒性休剋患兒容量複囌時給予白蛋白,能使循環更早穩定,無肺水腫髮生,提升難治性膿毒性休剋搶救成功率.
목적 비교정체액단용여가용백단백량충액체요법재소인농독성휴극중적치료작용.방법 채용회고성연구방법,수집하북성인동의원중증의학과수치적63례농독성휴극환인적림상자료,안조입원후1h내액체복소치료중시부급여백단백장환인분위량조.관찰조33례,우입원후30 min내수입생리염수20 mL/kg후재급여백단백1 g/kg진행복소치료;대조조30례,입원후30 min내수입생리염수20 mL/kg,병근거액체치료적반응정황계속급여생리염수확용.기타항감염급혈관활성약물사용원칙상동.비교량충방법치료환인적제일소시수액량、순배은정시간、폐수종발생솔급체표후0、6、12h혈유산수평,병계산혈유산청제솔.결과 관찰조환인제일소시수액량명현감소대조조(mL:41.56±10.50비57.24±7.54,t=4.596,P=0.000);체도순배은정시간소우대조조,단차이무통계학의의(min:219.87±70.23비287.10±67.00,t=2.047,P=0.360);폐수종발생솔략저우대조조[6.1％(2/33)비10.0％(3/30),x2=2.272,P=0.259].량조수복소시간연장,유산수평축점하강,유산청제솔축점승고;재복소후0h、6h,관찰조유산수평(mmol/L)명현저우대조조[0 h:3.65 ±2.84비5.72±2.11,t=1.940,P=0.046;6 h:2.12±1.21비4.09±1.45,t=2.892,P=0.005],유산청제솔교대조조명현승고[0 h:(0.38±0.15)％비(0.18±0.09)％,t=1.447,P=0.018;6 h:(0.62±0.14)％비(0.51±0.11)％,t=1.920,P=0.047];재복소후12h,관찰조여대조조간유산(mmol/L:1.46±0.39비1.54±1.90,t=0.450,P=0.072)급기청제솔[(0.78±0.19)％비(0.77±0.18)％,t=0.091,P=0.928]차이균무통계학의의.결론 농독성휴극환인용량복소시급여백단백,능사순배경조은정,무폐수종발생,제승난치성농독성휴극창구성공솔.
Objective To compare the effect of crystalloid and crystalloid plus albumin in the treatment of pediatric septic shock.Methods Data of 63 pediatric patients with septic shock admitted to Department of Critical Care Medicine of Hebei Provincial Children's Hospital were collected and retrospectively analyzed.The patients were divided into two groups according to whether they received albumin for volume resuscitation within 1 day after admission or not.The patients in observation group (crystalloid + albumin group,n =33) received normal saline (20 mL/kg) followed by 1 g/kg albumin 30 minutes after admission,and those in control group (crystalloid group,n =30) received only normal saline (20 mL/kg) 30 minutes after admission,and normal saline resuscitation was continued according to the effect of fluid therapy.Anti-infection and vasoactive drugs strategies were the same in both groups.The first-hour infusion volume,time showing stable hemodynamics,the incidence of pulmonary edema,and blood lactate levels at 0,6,12 hours after achieving the goals were compared,and blood lactate clearance rates were calculated.Results The first-hour infusion volume time in the observation group was lower than that in control group (mL:41.56 ± 10.50 vs.57.24 ± 7.54,t=4.596,P=0.000),and time showing stable hemodynamics was shorter than that in control group but without statistically significant difference (minutes:219.87 ±70.23 vs.287.10 ± 67.00,t=2.047,P=0.360).The incidence of pulmonary edema in observation group was slightly lower than that in control group [6.1％ (2/33) vs.10.0％ (3/30),x2±2.272,P=0.259].The lactic acid levels were decreased gradually along with rehabilitation time,while lactate clearance rate was increased in both groups.At 0 hour and 6 hours after resuscitation,the lactate level (mmol/L) in the observation group was significantly lower than that in control group [0 hour:3.65 ± 2.84 vs.5.72 ± 2.11,t＝ 1.940,P=0.046; 6 hours:2.12 ± 1.21 vs.4.09 ± 1.45,t=2.892,P=0.005],while the lactate clearance rate was significantly increased compared with control group [0 hour:(0.38 ± 0.15)％ vs.(0.18 ± 0.09)％,t=1.447,P=0.018; 6 hours:(0.62 ± 0.14)％ vs.(0.51 ± 0.11)％,t=1.920,P=0.047].However,at 12 hours after resuscitation,there were no statistically significant differences in the lactic acid level (mmol/L:1.46 ± 0.39 vs.1.54 ± 1.90,t=0.450,P=0.072) and the lactate clearance rate [(0.78 ± 0.19) ％ vs.(0.77 ± 0.18) ％,t =0.091,P=0.928] between observation group and control group.Conclusion Albumin resuscitation in children with septic shock can stabilize hemodynamics earlier,reduce the incidence of pulmonary edema,and improve the successful rescue rate of refractory septic shock.
