目的 与传统生理盐水复苏相比较,探讨3％高渗盐水在儿童脓毒性休克早期液体复苏中的作用.方法 前瞻性研究,采用随机数余数分组法,将首都儿科研究所附属儿童医院重症监护病房2012年1月至2014年1月收治的脓毒性休克患儿44例(男33例,女11例),分为生理盐水复苏组(NS组,24例)、3％高渗钠复苏组(HS组,20例),经静脉通路输入相应复苏液体,同时进行规范的抗休克治疗.监测液体复苏前后心率、平均动脉压(MAP)、动脉血乳酸、氧合指数(OI,=PaO2/FiO2)、尿量、血钠,计算24 h乳酸清除率;记录24 h输液量、正性肌力药物评分,小儿危重评分(PCIS)变化,机械通气时间,多器官功能障碍综合征发生率以及28 d死亡率.结果 (1)复苏后NS组和HS组心率、MAP较复苏前明显改善,两组间各时间点的心率、MAP比较差异无统计学意义.(2)与复苏前OI比较,HS组复苏后3h明显改善[(321.8±50.7)比(296.5±58.2) mmHg(1 mmHg=0.133 kPa),t=-2.50,P=0.018],NS组复苏后24 h改善[(325.7±62.6)比(304.2±70.4)mmHg,t=-2.60,P=0.016],两组各时间点OI比较差异无统计学意义.(3)HS组复苏后1h血钠高于NS组[(138.3±3.8)比(135.0±3.5) mmol/L,t=8.77,P=0.005],随后两组血钠浓度差异无统计学意义.(4)HS组6h及24h输液量(ml/kg)较NS组明显减少[6 h:(39.2±13.9)比(60.8±22.4),t=14.21,P=0.000;24 h:(102.9±27.7)比(130.6±33.2),t=8.85,P=0.005].两组6h、24h尿量比较差异无统计学意义(P＞0.05).(5)两组24h乳酸清除率、24 h PCIS、正性肌力药物评分、机械通气时间比较差异无统计学意义.两组多器官功能障碍综合征发生率(HS组80.0％,NS组70.0％)及28 d死亡率(HS组5.0％,NS组8.3％)比较,差异无统计学意义.结论 3％高渗盐水在儿童脓毒性休克的早期液体复苏中可以安全有效的改善血流动力学状态,比传统生理盐水复苏改善氧合更快,而且复苏液体量明显减少.
目的 與傳統生理鹽水複囌相比較,探討3％高滲鹽水在兒童膿毒性休剋早期液體複囌中的作用.方法 前瞻性研究,採用隨機數餘數分組法,將首都兒科研究所附屬兒童醫院重癥鑑護病房2012年1月至2014年1月收治的膿毒性休剋患兒44例(男33例,女11例),分為生理鹽水複囌組(NS組,24例)、3％高滲鈉複囌組(HS組,20例),經靜脈通路輸入相應複囌液體,同時進行規範的抗休剋治療.鑑測液體複囌前後心率、平均動脈壓(MAP)、動脈血乳痠、氧閤指數(OI,=PaO2/FiO2)、尿量、血鈉,計算24 h乳痠清除率;記錄24 h輸液量、正性肌力藥物評分,小兒危重評分(PCIS)變化,機械通氣時間,多器官功能障礙綜閤徵髮生率以及28 d死亡率.結果 (1)複囌後NS組和HS組心率、MAP較複囌前明顯改善,兩組間各時間點的心率、MAP比較差異無統計學意義.(2)與複囌前OI比較,HS組複囌後3h明顯改善[(321.8±50.7)比(296.5±58.2) mmHg(1 mmHg=0.133 kPa),t=-2.50,P=0.018],NS組複囌後24 h改善[(325.7±62.6)比(304.2±70.4)mmHg,t=-2.60,P=0.016],兩組各時間點OI比較差異無統計學意義.(3)HS組複囌後1h血鈉高于NS組[(138.3±3.8)比(135.0±3.5) mmol/L,t=8.77,P=0.005],隨後兩組血鈉濃度差異無統計學意義.(4)HS組6h及24h輸液量(ml/kg)較NS組明顯減少[6 h:(39.2±13.9)比(60.8±22.4),t=14.21,P=0.000;24 h:(102.9±27.7)比(130.6±33.2),t=8.85,P=0.005].兩組6h、24h尿量比較差異無統計學意義(P＞0.05).(5)兩組24h乳痠清除率、24 h PCIS、正性肌力藥物評分、機械通氣時間比較差異無統計學意義.兩組多器官功能障礙綜閤徵髮生率(HS組80.0％,NS組70.0％)及28 d死亡率(HS組5.0％,NS組8.3％)比較,差異無統計學意義.結論 3％高滲鹽水在兒童膿毒性休剋的早期液體複囌中可以安全有效的改善血流動力學狀態,比傳統生理鹽水複囌改善氧閤更快,而且複囌液體量明顯減少.
목적 여전통생리염수복소상비교,탐토3％고삼염수재인동농독성휴극조기액체복소중적작용.방법 전첨성연구,채용수궤수여수분조법,장수도인과연구소부속인동의원중증감호병방2012년1월지2014년1월수치적농독성휴극환인44례(남33례,녀11례),분위생리염수복소조(NS조,24례)、3％고삼납복소조(HS조,20례),경정맥통로수입상응복소액체,동시진행규범적항휴극치료.감측액체복소전후심솔、평균동맥압(MAP)、동맥혈유산、양합지수(OI,=PaO2/FiO2)、뇨량、혈납,계산24 h유산청제솔;기록24 h수액량、정성기력약물평분,소인위중평분(PCIS)변화,궤계통기시간,다기관공능장애종합정발생솔이급28 d사망솔.결과 (1)복소후NS조화HS조심솔、MAP교복소전명현개선,량조간각시간점적심솔、MAP비교차이무통계학의의.(2)여복소전OI비교,HS조복소후3h명현개선[(321.8±50.7)비(296.5±58.2) mmHg(1 mmHg=0.133 kPa),t=-2.50,P=0.018],NS조복소후24 h개선[(325.7±62.6)비(304.2±70.4)mmHg,t=-2.60,P=0.016],량조각시간점OI비교차이무통계학의의.(3)HS조복소후1h혈납고우NS조[(138.3±3.8)비(135.0±3.5) mmol/L,t=8.77,P=0.005],수후량조혈납농도차이무통계학의의.(4)HS조6h급24h수액량(ml/kg)교NS조명현감소[6 h:(39.2±13.9)비(60.8±22.4),t=14.21,P=0.000;24 h:(102.9±27.7)비(130.6±33.2),t=8.85,P=0.005].량조6h、24h뇨량비교차이무통계학의의(P＞0.05).(5)량조24h유산청제솔、24 h PCIS、정성기력약물평분、궤계통기시간비교차이무통계학의의.량조다기관공능장애종합정발생솔(HS조80.0％,NS조70.0％)급28 d사망솔(HS조5.0％,NS조8.3％)비교,차이무통계학의의.결론 3％고삼염수재인동농독성휴극적조기액체복소중가이안전유효적개선혈류동역학상태,비전통생리염수복소개선양합경쾌,이차복소액체량명현감소.
Objective The mainstay of therapy in patients with septic shock is early and aggressive intravenous fluid resuscitation.However the type of intravenous fluid that would be ideal for managing septic shock has been intensely debated.In this study,the authors observed the effects of 3％ hypertonic saline solution compared with normal saline solution as early fluid resuscitation in children with septic shock.Method In this prospective study,44 septic shock children seen in the intensive care unit (ICU) of the Children's Hospital Affiliated to Capital Institute of Pediatrics were enrolled from January 2012 to January 2014,of whom 33 were male and 11 were female.Patients were randomly divided into two groups:normal saline group (NS group,24 patients) and 3％ hypertonic saline group (HS group,20 patients).There were no significant differences between the 2 groups of patients in age,gender,pediatric critical illness score (PCIS),oxygenation index (OI =PaO2/FiO2),arterial lactate,initial hemodynamic parameters,serum sodium and treatment at time of admission.Patients in NS group received normal saline guided by standard therapy.Those in HS group received 6 ml/kg 3％ hypertonic saline as a single bolus over l0 min to 15 min with a maximum of 2 boluses and other standard therapy.Heart rate (HR),mean arterial blood pressure (MAP),arterial lactate,oxygenation index,urine output,serum sodium,lactate clearance rate,PCIS,fluid infusion volume,vasoactive-inotropic score,mechanical ventilation time,as well as incidence of multiple organ dysfunction syndrome (MODS),and 28 days in-hospital mortality were recorded for all patients.Result (1)HR,MAP in both groups were significantly higher after infusion than those on admission.There were no significant difference in HR and MAP at 1h,3h,6h and 24h after infusion between NS group and HS group.(2) OI in HS group was significantly higher than that on admission at 3 hours after infusion [(321.8 ± 50.7) vs.(296.5 ± 58.2) mmHg,t =-2.50,P =0.018]),and it was significantly higher at 24 hours after infusion in NS group [(325.7 ± 62.6) vs.(304.2 ± 70.4) mmHg,t =-2.60,P=0.016].There were no significant differences in OI at 1h,3h,6h and 24h after infusion between NS group and HS group.(3) At 1 hour after infusion,serum sodium in HS group was significantly higher than that in NS group [(138.3 ± 3.8) vs.(135.0 ± 3.5) mmol/L,t =8.77,P =0.005],and then no significant difference at 3h,6h and 24h after infusion between two groups.(4)At 6 hours and 24 hours after treatment,fluid infusion volume in HS group was markedly less than that in NS group [6 h:(39.2 ± 13.9)vs.(60.8±22.4) ml/kg,t=14.21,P=0.000;24 h:(102.9 ±27.7)vs.(130.6±33.2)ml/kg,t =8.85,P =0.005].Urine output had not significant different between the two groups.(5)There were no significant differences in 24h PCIS,24h lactate clearance rate,vasoactive-inotropic score and mechanical ventilation time between the two groups.The incidence of MODS (80.0％ in HS group,70.0％ in NS group)and mortality rate(5.0％ in HS group,8.3％ in NS group) were similar in both groups.Conclusion The 3％ hypertonic saline was effective as resuscitation fluid in pediatric septic shock with respect to restoration of hemodynamic stability without obvious side effects.Hypertonic saline could more rapidly improve oxygenation and need less fluid infusion volume compared with normal saline.
