限制性输液措施在小儿感染中毒性休克麻醉中的作用分析

发布时间：2018-05-24 14:20

本文选题：感染性休克 + 手术　；参考：《重庆医学》2017年30期

【摘要】：目的比较限制性输液与充分液体复苏在小儿感染中毒性休克麻醉中的效果,探究补充液体的最佳方案。方法选取该院2013年1月至2016年1月收治的感染中毒性休克患儿40例,均急诊行手术治疗,根据随机数字表法分为A组和B组各20例,A组给予限制性输液,B组给予常规充分液体复苏。回顾性分析患儿的临床资料,比较两组手术相关指标、检验指标、术后机械通气时间、术后重症监护室时间及转归情况。结果所有患儿顺利完成手术,A组术中平均动脉压、中心静脉压、尿量、总输液量及出血量均低于B组,差异均有统计学意义(P0.05);A组术中动脉血氧分压高于B组,差异有统计学意义(P0.05)。术后2d时A组静脉血白细胞计数、高敏C-反应蛋白、白细胞介素-6和降钙素原均低于B组,差异均有统计学意义(P0.05)。A组术后机械通气时间和入住重症监护室时间均短于B组,差异有统计学意义(P0.05)。A组术后多器官功能障碍综合征和急性呼吸窘迫综合征发生率分别为5.0%(1/20)和10.0%(2/20),B组为25.0%(5/20)和35.0%(7/20),差异均有统计学意义(P0.05)。结论对于感染中毒性休克需手术治疗的患儿,术中限制性输液利于改善血流灌注,降低出血量及术后并发症发生率,效果优于充分液体复苏。
[Abstract]:Objective to compare the effects of restrictive infusion and sufficient fluid resuscitation on toxic shock anesthesia in infantile infection. Methods from January 2013 to January 2016, 40 children with toxic shock were treated with emergency operation. According to the random number table method, 20 cases in group A and 20 cases in group B were divided into two groups: group A and group B were given conventional fluid resuscitation. The clinical data of the children were analyzed retrospectively. The operative indexes, the test indexes, the time of mechanical ventilation, the time of intensive care unit after operation and the outcome were compared between the two groups. Results the mean arterial pressure, central venous pressure, urine volume, total transfusion volume and blood loss in group A were significantly lower than those in group B (P 0.05). The difference was statistically significant (P 0.05). On the 2nd day after operation, the venous white blood cell count, Gao Min C-reactive protein, interleukin-6 and procalcitonin in group A were lower than those in group B, and the difference was statistically significant (P 0.05). The time of mechanical ventilation and stay in intensive care unit in group A was shorter than that in group B. The incidence of multiple organ dysfunction syndrome and acute respiratory distress syndrome in group A was 5.0 / 20 and 25.0 / 20 in group B, respectively. The difference was statistically significant (P 0.05). Conclusion for children who need surgical treatment for toxic shock, limited infusion during operation is beneficial to improve blood flow perfusion, reduce blood loss and postoperative complications, and the effect is better than that of full fluid resuscitation.
【作者单位】：南京医科大学附属儿童医院麻醉科;
【分类号】：R726.1

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