液体平衡状态与儿童脓毒性休克预后的关系

The relationship between the condition of fluid balance and the prognosis of pediatric patients with septic shock

目的研究液体平衡状态与儿童脓毒性休克预后的关系,以便指导治疗并帮助判断预后。方法44例脓毒性休克患儿,开始抗休克治疗时进行小儿危重症评分,监测每日液体平衡状态,比较不同液体平衡状态与患儿预后的关系。结果开始抗休克治疗的5 d内发生液体负平衡组27例,25例存活;液体正平衡组17例,9例存活,液体负平衡组存活率明显高于正平衡组(P<0.01)。存活患儿有5例液体负平衡出现在治疗第1天,12例出现在第2天,5例出现在第3天,1例出现在第4天,2例出现在第5天,存活患儿液体负平衡多数发生在抗休克治疗的前3 d。结论脓毒性休克患儿抗休克治疗的前5 d内发生液体负平衡提示预后良好。

Objective To explore the relationship between the condition of fluid balance and the prognosis of pediatric patients with septic shock. Methods Forty-four patients with septic shock were enrolled in this study and were scored using pediatric critical illness score （PCIS） at the beginning of treatment. We monitored the fluid balance and studied the relationship between the different condition of fluid balance and the prognosis. Results Twenty-five of 27 patients who achieved a negative fluid balance during the first 5 days of treatment survived, only 9 of 17 patients who failed to achieve a negative fluid balance survived. At least 1 day of negative fluid balance in the first 5 days of treatment strongly predicted the better outcome （P 〈 0.01 ）. The negative balance of 5 patients occurred at the first day of treatment, 12 patients occurred at the second day, 5 occurred at the third day, 1 occurred at the 4th day and 2 occurred at the 5th day. At least 1 day of negative fluid balance often occurred in the first 3 days of treatment in survivals. Conclusion The negative fluid balance achieved in the first 5 days of treatment portends a good prognosis in pediatric septic shock.