摘要
目的：观察超量扩容、快速脱水、早期强心３项措施在小儿感染性休克治疗中的疗效。方法：将９８例小儿感染性休克患儿按２∶１随机分为甲组６５例，乙组３３例，甲组以２∶１液（用０．９％盐水２份与１．４％碳酸氢钠１份组成）加５％碳酸氢钠及６％低分子右旋糖酐等大量快速扩容；以２０％甘露醇、速尿快速脱水，以西地兰、川芎嗪注射液早期强心治疗。乙组按感染性休克常规治疗，以２∶１液或６％低分子右旋糖酐１０～２０ｍｌ／ｋｇ快速扩容，仅在发现脑水肿指征时给脱水剂，在出现心力衰竭指征时给强心剂；２组抗生素、血管活性药、地塞米松及能量合剂等综合治疗措施完全相同。结果：甲组治愈率８７．６９％，乙组为６０．６１％（Ｐ＜０．０１）；甲组有尿时间（１．８７±１．０２）小时，血压恢复正常时间（１．８４±０．７９）小时，脉搏及心跳有力时间（１．９０±０．８１）小时，四肢转温时间（２．５１±０．３６）小时，均较乙组为快（Ｐ均＜０．０１）。结论：对小儿感染性休克采取的３项改进措施疗效明显。
Objective :To observe the curative effects of three
items,including overvolemic expansion,rapid dehydration and early inotropic drug,on children
with infectious shock. Methods :98 children with infectious shock were randomly divided in the
proportion of two to one into A group (n=65) and B group (n=33).The A group was treated with
rapidly overvolemic expansion using 21 solution (09% sodium chloride two portions and 14%
sodium bicarbonate one portion) plus 5% sodium bicarbonate plus 6% low molecular weight
dextran,rapid dehydration using 20% mannitol and frusemide,and early inotropic therapy using
cedilanid and tetramethylpyrazine injection,but the B group treated with conventional therapy
for infectious shock,including rapid expansion using 21 solution or 6% low molecular weight
dextran dehydration drugs only when indications of brain edema were found,and inotropic drugs
when heart failure was appeared.In both A and B groups the generally therapeutic
measures(antibiotics,vasoactivate drugs,dexamethasone,and energetic mixture) were same.
Results :The cured rate was 8769% in A group otherwise 6061% in B group (P<001).All the times
for beginning to have urine (187102)h,blood pressure to return to normal (184079)h,pulse and
heart beat to become stronger (190081)h,and extremities to turn to warm (251036)h in A group
were significantly quicker than those in B group (all P<001). Conclusions :Three improved
measures used in treatment for infectious shock of children possess markedly curative effects.
关键词
感染性休克
儿童
扩容
脱水
强心
infectious shock
child
volemic expansion
dehydration
inotropism
