液体复苏治疗小儿脓毒血症休克的临床效果观察

Clinical Effect of Fluid Resuscitation in Treatment of Pediatric Septic Shock

目的:探讨小儿脓毒血症休克的有效液体复苏治疗方法及效果。方法:选取2015年1月-2017年1月本院收治的76例脓毒血症休克患儿,采用随机数字表法分为对照组与观察组,每组各38例。对照组患儿采用单纯晶体液复苏方案,观察组患儿在此基础上给予白蛋白联合治疗,比较两组患儿的第1小时液体输注量、住院时间、循环稳定时间、肺水肿发生率以及血乳酸水平。结果:观察组患儿的第1小时液体输注量为(40.8±7.3)m L,循环稳定时间为(183.2±49.1)min,住院时间为(10.1±5.2)d,在液体复苏30 min后的乳酸水平为(3.4±2.2)mmol/L,乳酸清除率为(0.4±0.2)%;液体复苏6 h后乳酸水平为(2.1±1.1)mmol/L,乳酸清除率为(0.6±0.2)%,均优均明显优于对照组,两组比较差异有统计学意义(P<0.05)。结论:液体复苏治疗小儿脓毒血症休克疗效确切,在液体复苏时联合应用白蛋白可缩短循环稳定时间与住院时间,迅速改善患儿血乳酸浓度,提高临床抢救成功率。

Objective：To evaluate the effect of fluid resuscitation in the treatment of pediatric patients with septic shock.Method：From January 2015 to January 2017,76 pediatric patients with septic shock in our hospital were selected and randomly divided into control group and observation group according to the random number table method,38 cases in each group.The pediatric patients in control group were treated with saline resuscitation,and the pediatric patients in observation group were treated with albumin on the basis of used saline resuscitation.The volume of liquid infusion at first hour,time of stabilify circulation and hospitalization, incidence of pulmonary edema and serum lactate were compared between the two groups.Result：In the observation group,the volume of liquid infusion at first hour was（40.8±7.3）m L,the time of stabilify circulation was（183.2±49.1）min,the hospitalization time was（10.1±5.2）d,all better than those in the control group, the differences were statistically significant（P〈0.05）.The level of serum lactate was（3.4±2.2） mmol/L and the lactate clearance rate was（0.4±0.2）% at 30 minutes after fluid resuscitation,the serum lactate was（2.1±1.1） mmol/L and the lactate clearance rate was（0.6±0.2）% at 6 hours after fluid resuscitation,which were all better than those of the control group, the differences were statistically significant（P〈0.05）.Conclusion：Fluid resuscitation in treatment of pediatric septic shock has definite clinical effect.combine albumin during fluid resuscitation can shorten the time of stabilify circulation and hospitalization,decrease serum lactate rapidly,ensure the success rate of clinical rescue.