摘要
目的:收集肯尼亚住院患儿病例,研究毛细血管再灌注时间延迟(dCRT,】3 s)作为预测患儿预后指标的价值。方法:研究Kilifi区医院4 160例患儿病例,其疾病类型包括:疟疾、疟源性贫血、急性呼吸道感染(ARI)、重度贫血(血红蛋白【50 g/L)、胃肠炎、营养不良、脑膜炎和脓毒症。结果:346例发生dCRT,占8%
Aims: To determine whether delayed capillary refill time (> 3 seconds) is a useful prognostic indicator in Kenyan children admitted to hospital. Methods: A total of 4160 children admitted to Kilifi District Hospital with malaria, malarial anaemia, acute respiratory tract infection (ARI), severe anaemia (haemoglobin < 50 g/l), gastroenteritis, malnutrition, meningitis, or septicaemia were studied. Results: Overall, delayed capillary refill time (dCRT), present in 346/4160 (8% ) of the children, was significantly more common in fatal cases (44/189, 23% ) than survivors (7. 5% ), and had useful prognostic value. In children admitted with malaria, gastroenteritis, or malnutrition, likelihood ratio tests suggested that dCRT was useful in identifying high risk groups for mortality, but its prognostic value in anaemia, ARI, and sepsis was unclear due to low case fatality or limited numbers. The severity features of impaired consciousness and deep breathing were significantly associated both with the presence of dCRT and fatal outcome. In children, with either of these severity features, a less stringent value of dCRT( > 2 s) identified 50% of children with hypotension (systolic BP < 2SD) and 40% of those requiring volume resuscitation (for metabolic acidosis). Conclusions: Although CRT is a simple bedside test, which may be used in resource poor settings as a guide to the circulatory status, dCRT should not be relied on in the absence of other features of severity. In non-severe disease, the additional presence of hypoxia, a moderately raised creatinine ( > 80 μmol/l), or a raised white cell count should prompt the need for fluid expansion.
