快速液体复苏治疗小儿脓毒症休克疗效分析

Analysis of the Clinical Efficacy of Rapid Fluid Resuscitation in the Treatment of Pediatric Septic Shock

目的研究快速液体复苏治疗小儿脓毒症休克的临床疗效。方法按照随机数表法将2016年3月至2018年3月遵义市第一人民医院儿童重症医学科收治的106例脓毒症休克患儿随机分为观察组(53例)和对照组(53例),其中观察组患儿采用快速液体复苏方式予以治疗,对照组患儿采用传统扩容方式予以治疗,对比观察两组患儿的血清中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase associated lipocalin,NGAL)、α1 微球蛋白、尿素氮及肌酐水平以及尿量、循环稳定时间、补液量、并发症发生率、死亡率与住院时间。结果治疗前,两组患儿血清NGAL、α1 微球蛋白、尿素氮、肌酐水平及尿量对比,P均>0.05,差异无统计学意义,具有可比性;治疗后,两组患儿血清NGAL、α1 微球蛋白、尿素氮及肌酐水平对比,P均>0.05,差异无统计学意义,而观察组患儿尿量多于对照组,两组对比,P<0.05,差异具有统计学意义。观察组患儿循环稳定时间、住院时间均短于对照组,补液量多于对照组,并发症发生率及死亡率均低于对照组,两组对比,P均<0.05,差异具有统计学意义。结论快速液体复苏可缩短脓毒症休克患儿的循环稳定时间及住院时间,降低急性肾损伤、肺水肿等并发症及死亡的发生率,疗效显著,且安全性较高,值得临床推广使用。

Objective To investigate the clinical efficacy of rapid fluid resuscitation in the treatment of pediatric septic shock.Methods One hundred and six children patients with septic shock admitted into the Pediatric Intensive Medicine Department of The First People’s Hospital of Zunyi between March 2016 and March 2018 were randomly divided into an observation group(53 patients)and a control group(53 patients)according to the random number table.In the observation group the patients were treated with rapid fluid resuscitation while the patients in the control group were treated with the traditional volume expansion therapy for shock.The following indexes were observed and compared between the two groups,including the expression levels of neutrophil gelatinase-associated lipocalin(NGAL),α1-microglobulin,blood urea nitrogen and creatinine in serum,urine volume,time for circulation stabilization,volume of fluid input,occurrence rate of complications,mortality and hospitalization duration.Results Before the treatment,the two groups were compared in terms of the expression levels of NGAL,al-microglobulin,blood urea nitrogen and creatinine in serum,and urine volume,and the results all showed no statistically significant difference,P>0.05 presenting comparability between the two groups.After the treatment,the expression levels of NGAL,α1-microglobulin,blood urea nitrogen and creatinine in serum were respectively compared between the two groups and the results all showed no statistically significant difference,P>0.05.However,the urine volume in the observation group was higher than that in the control group,and the comparison between the two groups showed a statistically significant difference,P<0.05.And also,statistically significant differences were observed when the two groups were compared in terms of time for circulation stabilization,volume of fluid input,occurrence rate of complications, mortality and hospitalization duration,all P<0.05.Conclusion Rapid fluid resuscitation,with its high safety,can shorten the time for circulation stabilization and hospitalization duration of children patients with septic shock,decrease the occurrence rate of complications,including acute kidney injury,pulmonary edema and etc.,and mortality,deserving to be promoted in clinical practice.