超声心输出量监测仪(USCOM)在重症肺炎合并脓毒性休克患儿血流动力学评估和治疗中的应用

Ultrasonic Cardiac Output Monitor (USCOM) Application in Severe Pneumonia Complicated Septic Shock of Hemodynamic Assessment and Treatment in Children

摘要: 目的：探讨超声心输出量监测仪(USCOM)对重症肺炎合并脓毒性休克患儿病情评估及指导治疗的应用价值。方法：选取2019年1月~2020年5月由门急诊收至青岛大学附属医院儿科重症医学科住院，诊断为重症肺炎合并脓毒性休克的患儿。行USCOM血流动力学监测患儿作为观察组，以同期未给予USCOM监测且资料完整患儿作为对照组。两组均按照儿童社区获得性肺炎与脓毒性休克诊疗常规治疗，观察组除接受常规治疗外，还根据USCOM监测数据调整液体入量及血管活性药物。观察组记录液体复苏及血管活性药物治疗前后的血流动力学参数并进行比较。记录并比较两组患儿液体入量及血管活性药物用量。比较两组患儿并发症发生率、机械通气时间、转为非危重病例时间、PICU住院时间和病死率。结果：① 截至2020年5月31日，共纳入病例57例，观察组29例，对照组28例。两组治疗前一般情况差异无统计学意义(P > 0.05)。② 观察组给予液体干预患儿共29例，治疗后HR、CI、SVRI、SVI、FTc、SMII均改善，较治疗前差异有统计学意义(P < 0.05)；给予血管活性药物干预患儿共12例，治疗后HR、CI、SVRI、SVI、FTc、SMII均显著好转，较治疗前差异有统计学意义(P < 0.05)。③ 观察组液体复苏29例，液体量(43.7 ± 8.33 ml/kg)；对照组28例，液体量(54.59 ± 6.15 ml/kg)。观察组应用多巴胺12例，用量(47.2 ± 4.76 mg/kg)；对照组15例，用量(69.63 ± 7.45 mg/kg)，观察组复苏液体入量及血管活性药物用量均少于对照组，差异有统计学意义(P < 0. 05)。④ 观察组并发症发生率、机械通气时间、转为非危重病例时间均少于对照组，差异有统计学意义(P < 0.05)；两组PICU住院时间及病死率差异无统计学意义(P > 0.05)。结论：USCOM操作简便，能够精准评估重症肺炎合并脓毒性休克患儿血流动力学状态，个体化指导容量管理及血管活性药物应用，具有重要临床应用及推广价值。

Abstract: Objective: To evaluate the application value of ultrasonic cardiac output monitor (USCOM) on children with severe pneumonia complicated septic shock in condition assessment and diagnosis and treatment. Methods: Select January 2019 to May 2020 diagnosed as children with severe pneumonia complicated septic shock, admitted through the outpatient and emergency to Department of Pediatric Intensive Care Medicine, the Affiliated Hospital of Qingdao University. Using USCOM hemodynamic monitoring children as observation group, without giving USCOM monitoring children with complete data the same period as control group. Two groups are given treatment in accordance with community-acquired pneumonia in children with routine therapy of septic shock diagnosis, the observation group in addition to conventional treatment, also according to the USCOM monitoring data adjust the amount of liquid and vascular active drugs. The observation group compares the hemodynamic indicators before and after treatment. Record and compare the fluid resuscitation and vascular active drug dosage before and after treatment of two groups. Compare two groups of children with complications, mechanic ventilation time, into the non-severe cases, PICU hospitalization time and mortality. Results: ① As of May 31, 2020, 57 cases were included, observation group 29 cases, control group 28 cases. The general information two groups before treatment has no statistically significant difference (P > 0.05). ② The observation group was given liquid intervention with 27 cases. The HR, CI, SVRI, SVI, FTc SMII after treatment are improved compared with those before treatment, and the differences had statistically significant (P < 0.05). The observation group was given vascular active drug intervention with 12 cases. The HR, CI, SVRI, SVI, FTc SMII after treatment are significant improved compared with those before treatment，and the differences had statistically significant (P < 0.05). ③ There are 29 cases in observation group application liquid recovery, liquid volume (43.7 ± 8.33 ml/kg), 28 cases in the control group, the liquid volume (54.59 ± 6.15 ml/kg). There are 12 cases in observation group application dopamine, dosage (47.2 ± 4.76 mg/kg). 15 cases in the control group, dosage (69.63 ± 7.45 mg/kg), the observation group recovery liquid intake and vascular active drug dosage is less than the control group, the differences had statistically significant (P < 0.05). ④ The complication rate, mechanic ventilation time, into the non-severe cases time of observation group were less than the control group, the differences had statistically significant (P < 0.05). Two groups in PICU hospitalization time and mortality had no statistical significance difference (P > 0.05). Conclusion: USCOM is easy to operate, can accurately evaluate hemodynamic status in children with severe pneumonia with septic shock, individualized instruction capacity management and vascular active drug application, has the important clinical application and popularization value.