摘要
目的探讨床旁超声测定下腔静脉内径(IVCD)及呼吸变异度(RVI)评估儿童脓毒性休克患者容量反应性的临床价值。方法选取2017年1月至2018年12月深圳市儿童医院儿童重症医学科(PICU)收治的30例脓毒性休克患儿作为休克组,在液体复苏前后床旁超声测定IVCD及RVI,记录患儿心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)。选取我院同期全麻气管插管的腹股沟斜疝患儿30例作为对照组,手术前超声测定下腔静脉上述指标。比较两组IVCD和RVI的差异,观察CVP和IVCD、CVP和RVI间的相关性。结果休克组患儿液体复苏前IVCDmax、IVCDmin均小于对照组[(0.75±0.09) vs (1.06±0.07);(0.57±0.10) vs (0.98±0.08)],RVI高于对照组[(24.35±6.88)vs (7.56±2.61)],差异均有统计学意义(P<0.05);液体复苏后0 h和2 h,休克组患儿的CVP、IVCDmax、IVCDmin均比复苏前明显增加,HR和RVI明显降低,差异均有统计学意义(P<0.05);CVP与液体复苏后IVCDmax、IVCDmin呈正相关(r=0.634,0.657,P<0.05),与RVI呈负相关(r=-0.751,P<0.05)。结论 IVCD及RVI与儿童脓毒性休克患者容量反应性相关,床旁超声动态监测能够指导儿童脓毒性休克患者进行液体复苏。
Objective To assess the clinical value of inferior vena cava diameter (IVCD) and respiratory variability index (RVI) measured by bedside ultrasound for predicting fluid responsiveness in pediatric septic shock. Methods A total of 30 children with septic shock admitted to PICU, Shenzhen Children's Hospital from January 2017 to December 2018 were enrolled as the shock group. IVCD and RVI were measured by ultrasound before and after fluid resuscitation, and heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP) were recorded. Thirty childrem of inguinal hernia undergoing general anesthesia and tracheal intubation were selected as the control group. The differences between IVCD and RVI in the two groups were compared, and the correlations between CVP and IVCD, CVP and RVI were observed. Results IVCDmax and IVCDmin in the shock group were 0.75±0.09, 0.57±0.10, significantly lower than 1.06±0.07, 0.98±0.08 in the control group;RVI was 24.35±6.88, significantly higher than 7.56±2.61 in the control group;the differences were statistically significant (P<0.05). At 0 h and 2 h after fluid resuscitation, CVP, IVCDmax, and IVCDmin were significantly increased, while HR and RVI were significantly decreased (P<0.05). CVP was positively correlated with IVCDmax and IVCDmin after resuscitation (r=0.634, 0.657, P<0.05), and negatively correlated with RVI (r=-0.751, P<0.05). Conclusion IVCD and RVI are correlated with volume responsiveness in children with septic shock. Bedside ultrasound dynamic monitoring can guide the fluid resuscitation in children with septic shock.
作者
武宇辉
杨燕澜
马伟科
李莉
于芹
周慧
杨卫国
WU Yu-hui;YANG Yan-lan;MA Wei-ke;LI Li;YU Qin;ZHOU Hui;YANG Wei-guo(Pediatric Intensive Care Unit (PICU),Shenzhen Children's Hospital,Shenzhen 518038,Guangdong,CHINA)
出处
《海南医学》
CAS
2019年第17期2249-2251,共3页
Hainan Medical Journal
基金
广东省深圳市卫生计生系统科研项目(编号:201606035)
关键词
儿童
脓毒性休克
下腔静脉
超声
容量反应性
呼吸变异度
Pediatric
Septic shock
Inferior vena cava
Ultrasond
Volume responsiveness
Respiratory variability
