骨髓内输液与传统输液在危重症患儿急救中的临床对比研究

Clinical comparison of intraosseous versus traditional infusion in critical pediatric patients under resuscitation

目的：比较骨髓内输液（IOI）与传统输液（静脉切开或中心静脉穿刺输液）在危重症患儿急救中的临床疗效及并发症。方法分析符合标准的56例外周静脉穿刺失败的危重症患儿，按急救时输液方式不同分为 IOI 组和传统组，详细记录患儿基本资料、实验室检查、治疗效果以及并发症。结果 IOI 组建立通道平均时间（1．01±0．53）min，明显短于传统输液组的（8．97±2．36）min（t ＝4．856，P ＜0．01）；有效循环恢复时间有缩短趋势[（13．54±3．49）min 比（15．26±2．63）min，P ＞0．05]。IOI 组患儿临床疗效优于传统组（IOI组50．0％，传统组36．7％）；16．4％治疗无效率也明显低于传统组的26．6％（χ2＝18．476，P ＜0．05）。与传统组相比，IOI 组患儿相关并发症发生率（11．5％）和病死率（7．7％）均较低（χ2＝10．716，P ＜0．01和χ2＝8．978，P ＜0．05）。结论对于危重症患儿连续3次静脉穿刺失败或90 s 内仍不能建立有效输液通路者，骨髓内输液较传统输液方式更加快速、安全和有效。

Objective To compare the clinical effect of intraosseous versus traditional infusion in critical pediatric patients under resuscitation.Methods 56 critical pediatric patients under resuscitation,who were difficult to establish a venous access,were divided into two groups：intraosseous infusion group （IOI group）and traditional group.The clinical characteristics,lab tests,clinical efficacy and complications of all patients were recorded in detail. Results The general characteristics of two groups were comparable.The mean operation time to establish an emergency infusion access in the IOI group was （1.01 ±0.53）min,which was significantly shorter than （8.97 ±2.36）min of the traditional group（t =4.856,P 〈0.01）.The IOI group had a greater efficacy over the traditional group （50.0% vs 36.7%）,in the IOI group,the patients showed obvious positive effect and less patients had no efficacy（χ2 =18.476, P 〈0.05 ）.In addition,lower complication rate and mortality were observed in the IOI group.Conclusion For critical pediatric patients under resuscitation whose intravascular access cannot be achieved through peripheral venous,intraosseous infusion is prior to traditional infusion.