床旁重症超声对NICU脓毒性休克新生儿的诊治价值

An exploration of the diagnosis and therapeutic value of bedside severe ultrasound in neonates with NICU septic shock

目的探讨床旁即时超声(point-of-care ultrasound,POCUS)对NICU脓毒性休克新生儿的诊断及治疗价值。方法选取广东省第二人民医院NICU自2019年7月1日——2021年4月1日收治的30例脓毒性休克新生儿为POCUS评估组,同时选取30例同时期足月新生儿为对照组,并对两组新生儿均使用床旁超声进行血流动力学相关指标监测,分析两组新生儿的一般资料及脓毒性新生儿治疗前后血流动力学指标的差异及相关性,评估床旁超声对脓毒性休克新生儿的诊断及治疗价值。结果两组患儿的一般资料差异无统计学意义(P均>0.05)。评估组相对对照组,心率高于对照组、射血分数、心输出量、心脏指数、左室每博量均低于对照组,差异有统计学意义(P均<0.05)。评估组患儿经适当的液体复苏等治疗后各项血流动力学指标均较治疗前明显好转,治疗前后差异有统计学意义(P均<0.05),且液体复苏后各项血流动力学指标和对照组无明显差异(P均>0.05)。结论脓毒性休克新生儿的血流动力学指标在早期有变化,通过使用床旁即时超声可直观、迅速、密切了监测脓毒性休克新生儿的血流动力学指标变化,为早期诊断脓毒性休克,及时治疗及动态评估病情提供依据。

Objective To explore the diagnosis and therapeutic value of point-of-care ultrasound(POCUS)in neonates with NICU septic shock.Methods 30 neonates with septic shock admitted from NICU of the Second People’s Hospital of Guangdong Province from 2019-07-01 to 2021-04-01 were selected as the POCUS evaluation group,and 30 full-term neonates in the same period were selected as the control group.The hemodynamic indexes of both groups of neonates were monitored by bedside ultrasound,and the general information of the two groups of neonates and the difference and correlation of hemodynamic indexes of septic neonates before and after treatment were analyzed,to evaluate the diagnostic and therapeutic value of bedside ultrasound in neonates with septic shock.Results There was no significant difference in the two groups(P>0.05).Compared with the control group,the heart rate,ejection fraction,cardiac output,cardiac index,and left ventricular per blog volume were higher than the control group,which was statistically significant(P<0.05).The hemodynamic correlation index improved in newborns with septic shock(P<0.05).After fluid resuscitation,there was no significant difference in hemodynamic indexes between the two groups(P>0.05).Conclusion Hemodynamic indexes of neonates with septic shock change in the early stage.The hemodynamic indexes of neonates with septic shock can be monitored intuitively,rapidly and closely by using bedside real-time ultrasound,which provides a basis for early diagnosis of septic shock,timely treatment and dynamic evaluation of the disease.