无创血流动力学监测在儿童脓毒性休克早期液体复苏的临床应用

doi:10.3969/j.issn.1000-8535.2021.03.012

广州医药 ›› 2021, Vol. 52 ›› Issue (3): 56-60.DOI: 10.3969/j.issn.1000-8535.2021.03.012

无创血流动力学监测在儿童脓毒性休克早期液体复苏的临床应用

谭俊杰¹, 曹鹏辉², 梁桂林¹, 董艳飞¹, 郭影霞¹

1 清远市妇幼保健院儿科(清远 511510)
2 广州医科大学(广州 510180)

收稿日期:2020-11-08 发布日期:2021-11-24
通讯作者: 梁桂林,E-mail:lgl70513@163.com
基金资助:
清远市科技计划项目(190912114569162)

Clinical application of non-invasive cardiac output monitoring in the early fluid resuscitation of children with septic shock

TAN Junjie¹, CAO Penghui², LIANG Guilin¹, DONG Yanfei¹, GUO Yingxia¹

1 Qingyuan Maternal and Child Health Hospital,Qingyuan 511510,China
2 Guangzhou Medical University, Guangzhou 510180,China

Received:2020-11-08 Published:2021-11-24

摘要/Abstract

摘要： 目的探讨无创血流动力学监测(non-invasive cardiac output monitoring,NICOM)在儿童脓毒性休克早期液体复苏的临床应用评价。方法选取2019年1月—2020年6月期间在我院PICU患儿诊断为儿童脓毒性休克61例,随机分为对照组(未接受NICOM监测29例)和干预组(接受NICOM监测32例),记录液体复苏后6、12、24小时血气分析(pH值、剩余碱、乳酸)、尿量以及病死率、NICOM监测(CO、CI、SVR、SV、SVRI、HR、MAP)等结果。结果液体复苏6 小时后两组HR、MAP、乳酸、剩余碱、尿量比较无统计学差异 (P>0.05),液体复苏12 h后干预组乳酸较对照组降低,差异有统计学意义(P<0.05);液体复苏24 h后两组HR、MAP、乳酸、剩余碱及尿量比较,差异均有统计学意义 (P<0.05)。干预组治疗后12 h在CO、CI、SVR、SV、SVRI、HR、MAP较治疗前改善,差异均有统计学意义(P<0.05),干预组治疗后24 h在CO、CI、SVR、SV、SVRI、HR、MAP较治疗前改善,差异均有统计学意义(P<0.05)。结论 NICOM具有敏感度及准确率高,且操作简单,可有效用于指导脓毒性休克早期液体复苏,针对个体化治疗提供客观依据,正确指导容量管理,具有科学实用价值,值得推广。

关键词: 脓毒性休克, 无创血流动力学, 液体复苏, 早期

Abstract: Objective To evaluate the clinical application of non-invasive cardiac output monitoring (NICOM) for early fluid resuscitation in children with septic shock. Methods 61 children diagnosed with septic shock in the PICU at our hospital between January 2019 and June 2020 were randomly divided into a control group (29 without NICOM monitoring) and an intervention group (32 with NICOM monitoring), and the results of blood gas analysis (pH,lactate and residual base), urine volume, and mortality, and NICOM monitoring (CO, CI, SVR, SVRI, HR, and MAP) were recorded at 6, 12, and 24 h after fluid resuscitation. Results There was no statistically significant difference in HR, MAP, lactic acid, residual base and urine volume between the two groups after 6 h of fluid resuscitation (P>0.05), and lactic acid was lower in the intervention group than that in the control group after 12 h of fluid resuscitation (P<0.05); the differences in HR, MAP, lactic acid, residual base and urine volume between the two groups after 24 h of fluid resuscitation were all statistically significant (P<0.05). The differences were statistically significant (P<0.05) in CO, CI, SVR, SVI, HR, and MAP at 12 h and at 24 h after treatment in the intervention group compared with that of the pre-treatment (P<0.05). Conclusion NICOM has high sensitivity and accuracy and it can be operated in simple processes. It may be effectively applied to guide the early fluid resuscitation of septic shock. It also provides Objective evidence for individualized treatment and correctly guides volume management. Its scientific and practical value makes it worth promoting.

Key words: Septic shock, Non-invasive cardiac output monitoring, Fluid resuscitation, Early stage

谭俊杰, 曹鹏辉, 梁桂林, 董艳飞, 郭影霞. 无创血流动力学监测在儿童脓毒性休克早期液体复苏的临床应用[J]. 广州医药, 2021, 52(3): 56-60.

TAN Junjie, CAO Penghui, LIANG Guilin, DONG Yanfei, GUO Yingxia. Clinical application of non-invasive cardiac output monitoring in the early fluid resuscitation of children with septic shock[J]. Guangzhou Medical Journal, 2021, 52(3): 56-60.

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无创血流动力学监测在儿童脓毒性休克早期液体复苏的临床应用

Clinical application of non-invasive cardiac output monitoring in the early fluid resuscitation of children with septic shock

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