高原小儿外科感染性休克探讨

Surgical Septic Shock in Children at High Altitude

本文对105例高原小儿外科感染性休克进行了总结.临床观察和实验室资料表明,高原地区健康小儿的血液流态具有粘、浓、聚三大特点,微血管在缺氧环境下处于痉挛代偿状态.感染性休克时血管痉挛明显加重,持续时间长,代偿机能差,休克早期就会出现微循环障碍,因而高原小儿感染性休克具有发病急、进展快,病情重、病死率高等临床特点.早期诊断、早期治疗对于提高抢救成功率,降低病死率有重要意义.

This article reviewed 105 cases of surgical shock in children at high altitude.Their clinical features were:acute onset,rapid deterioration and high mortality.The results of the clinical observation,the examination of nail-fold microcirculation,HB,BP,3P test,platelete counts and the blood gas analysis showed that the blood stream of a healthy child at high altitude is characterized by higher viscosity,consistency and condensibility.Under anoxia,microvessels have been in a compensatory spasm state.In septic shock,the spasm of microvessels will be increased and prolonged,while the compensation of microcirculation will be reduced.In the early stage of shock,disorders of microcirculation may result to failure of circulation and respiration,to disfunction of heart and renals,to acute brain edema,and to DIC.Early diagnosis and proper comprehensive treatment,such as early inhalation of oxygen,correction of blood volume and acidosis,administration of hemodynamic drugs and elimination of the infectious focuscan improve the prognosis.