摘要
目的探讨重症超声在脓毒性休克患儿血管活性药物管理中的应用价值。方法收集从2010年~2021年改良的重症经胸超声检查(advanced critical care chest ultrasonic examination,A-CCUE)方案,在深圳市宝安区妇幼保健院PICU推广应用前后,危重症评分<80分脓毒性休克患儿血管活性药物使用情况及预后进行回顾性研究。2010年~2015年A-CCUE方案尚未应用,此阶段脓毒性休克患儿作为对照组(n=16)。2016年PICU的4位医生先后接受中国重症超声研究组培训并取得合格证书,A-CCUE方案逐渐被应用到我科的临床实践。2017年~2021年具有资质的PICU医生应用A-CCUE方案对脓毒性休克患儿进行血流动力学评估并指导血管活性药物精细化调整,此阶段患儿作为A-CCUE组(n=15)。两组患儿均给予脓毒症“集束化”治疗策略。A-CCUE组患儿入PICU后1h内接受A-CCUE方案评估,由操作医生负责将评估结果按照表单进行填写,之后根据病情每天动态进行A-CCUE流程评估。基于2个切面确定一个结果或者2位医生共同检查印证后确定的原则。结果A-CCUE组血管活性药物应用类型为肾上腺素及去甲肾上腺素使用多于对照组,差异有统计学意义(P<0.05)。A-CCUE组血管活性药物使用平均时间(4d)短于对照组(4.5d),差异有统计学意义(P<0.05)。两组血管活性药物评分无差异。两组患儿6h复苏目标达成指标包括血压恢复正常,乳酸正常及尿量(1mg/kg·h),两组无统计学差异。并发心力衰竭者,A-CCUE组患儿多于对照组,差异有统计学意义(P<0.05)。其余并发症如脑病、急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)、急性胃肠损(acute gastrointestinal injury,AGI)、急性肾损伤(acute kidney injury,AKI)及弥散性血管内凝血(Disseminated intravascular coagulation,DIC)的发生,两组无差异。A-CCUE组机械通气时间短于对照组,差异有统计学意义(P<0.05)。住PICU时间、PICU死亡率及28d死亡�
Objective To evaluate the value of critical ultrasound in the management of vasoactive agents in children with septic shock.Methods The data of the use of the vasoactive agents and prognosis of children with septic shock whose critical care score less than 80 scores was collected in Shenzhen Baoan women’s and children’s hospital before and after the application of advanced critical care chest ultrasonic examination(A-CCUE)from 2010 to 2021.The children with septic shock in 2010 to 2015 when A-CCUE protocol was not used were divided into control group(n=16).In 2016,four PICU doctors were trained by the Chinese critical ultrasound research group and obtained certificates,and from then the A-CCUE protocol was gradually applied in clinical practice.The A-CCUE scheme was used by the qualified PICU doctors to assess the hemodynamics of children with septic shock and used to guide the fine adjustment of vasoactive agents.The patients in this stage were divided into A-CCUE group(n=15).Two groups of children were given"Severe Sepsis Bundle"treatment strategy.Children in the A-CCUE group were assessed with A-CCUE within 1 hour after they were admitted to PICU.The assessment results were filled out by the operator according to the forms.The patients were then evaluated by the A-CCUE process dynamically on a daily basis as needed.The principle of determining a result based on two aspects or corroboration by a joint examination of two doctors.Results The use of adrenaline and noradrenaline in A-CCUE group was more than that in Control Group(P<0.05).The average time of using vasoactive agents in A-CCUE group(4 days)was shorter than that in control group(4.5 days),the difference was statistically significant(P<0.05).The vasoactive agents scores of the two groups have no difference.The goal of 6-hour resuscitation including normal blood pressure,normal lactate and urine volume(1 mg/kg·h).There were no difference between the two groups.The incidence of heart failure in A-CCUE group was higher than that in Control Group(P<0.0
作者
刘纯义
金萍
刘晓萍
罗勇
许锦姬
周涛
Liu Chunyi;Jin Ping;Liu Xiaoping;Luo Yong;Xu Jinji;Zhou Tao(The Department of Emergency and Pediatrics,Shenzhen Baoan Women's and Children's Hospital,Shenzhen,China)
关键词
改良的重症经胸超声检查
脓毒性休克
血管活性药物
Advanced critical care chest ultrasonic examination
Septic shock
Vasoactive agents
