床旁重症肺部超声进阶重症急会诊超声检查方案在重症患儿中的应用价值

The application value of Advance critical care chest ultrasonic examination in patients with severe diseases by bedside ultrasound

目的探讨床旁重症肺部超声检查(Advance-CCUE)流程方案在重症患儿中的应用价值。方法选取2020年12月至2022年12月于贵阳市妇幼保健院接受治疗的110例重症患儿作为研究对象,均施行Advance-CCUE流程方案,分析患者入院后48 h液体入量、液体出量、液体正平衡量、呋塞米、咪达唑仑、芬太尼用量;评估机械通气时间、住院时间、连续性肾脏替代治疗情况;比较治疗前后左心室射血分数(LVEF)、速度时间积分(VTI)、下腔静脉(IVC)最大径。结果治疗后,患儿液体入量(5.02±0.74)ml/(kg·h),液体出量(2.05±0.42)ml/(kg·h),液体正平衡量(4.65±1.26)ml/(kg·h),呋塞米用量(1.08±0.52)mg/(kg·d),咪达唑仑用量(1.42±0.52)µg/(kg·h),芬太尼用量(5.63±2.12)µg/(kg·min),机械通气时间(3.12±0.65)d,重症监护病房(PICU)住院时间(10.21±2.15)d;行连续性肾脏替代治疗2例(1.82%)。治疗后,患儿LVEF、VTI均高于治疗前,IVC最大径长于治疗前,差异有统计学意义(P<0.05)。结论运用Advance-CCUE流程对重症患儿行心功能、容量状况及容量反应评估,有利于更早、更准确地分辨休克类型及进行个体化液体管理。

Objective To explore the application value of bedside critical ultrasound advance critical care chest ultrasonic examination(Advance-CCUE)protocol in critically ill children.Methods 110 critically ill children admitted to Guiyang Maternal and Child Health Hospital from Decem-ber 2020 to December 2022 were selected as the research subjects,the Advance-CCUE process plan was adopted,the fluid intake,fluid output,and positive fluid balance,furosemide,midazolam,fentanyl dosage were analysed at 48 h after admission;to evaluate the duration of mechanical ventila-tion,hospital stay,the number of cases of continuous renal replacement therapy,and the mortality rate;left ventricular ejection fraction(LVEF),ve-locity-time integral(VTI)and inferior vena cava(IVC)maximum diameter were compared at before and after treatment.Results After treatment,fluid intake was(5.02±0.74)ml/(kg·h),fluid output was(2.05±0.42)ml/(kg·h),positive fluid balance was(4.65±1.26)ml/(kg·h),and the dosage of furosemide was(1.08±0.52)mg/(kg·d),the dosage of midazolam was(1.42±0.52)µg/(kg·h),the dosage of fentanyl was(5.63±2.12)µg/(kg·min),the duration of mechanical ventilation was(3.12±0.65)d,and the duration of pediatric intensive care unit(PICU)hospitalization was(10.21±2.15)d;continuous renal replacement therapy was performed in 2 cases(1.82%).After treatment,LVEF,VTI were higher than before treatment,IVC maxi-mum diameter was longer than before treatment,the differences were statistically significant(P<0.05).Conclusion The assessment of cardiac func-tion,volume status and volume response in critically ill children according to the Advance-CCUE process is helpful for earlier and more accurate dis-crimination of shock types and individualized fluid management.