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目的探讨血浆胶体渗透浓度(COP)监测在脓毒性休克液体复苏中的应用价值。方法 2005年11月至2009年6月中山大学附属东华医院重症监护室收住的脓毒性休克患儿47例,随机分为两组,均动态监测血浆胶体渗透浓度,并进行液体复苏。其中A组22例,不以胶体渗透浓度测定值作为参考指标,根据临床经验补液,即快速输液阶段采用生理盐水,继续和维持输液阶段晶体液:胶体液为2～3∶1。B组25例,动态监测测胶体渗透浓度,如低于正常,快速输液阶段采用较多胶体液,继续和维持输液阶段采用晶体液:胶体液为1∶1,如胶体渗透浓度正常,处理同A组。记录两组患儿平均动脉压(MAP),每小时尿量,中心静脉压(CVP),复苏液量,血管活性药用量,小儿危重病例评分(PCIS评分)等指标变化,并作统计学分析。结果两组患儿入科时COP,PCIS评分,MAP,CVP差异均无统计学意义,COP明显低于正常值范围。B组各时段胶体用量,COP均大于A组。第6、24hB组用的液体总量比A组少,第1、6hB组PCIS评分,每小时尿量,MAP,CVP均大于A组,各种血管活性药物用量均少于A组。第24h两组PCIS评分,每小时尿量,MAP,CVP无明显差别,但是B组各种血管活性药物用量少于A组。结论小儿脓毒性休克液体复苏中动态监测COP,以此依据调整复苏液的晶体胶体比例,可有效提高疗效。
Objective To investigate the value of plasma colloid osmotic concentration (COP) monitoring in septic shock fluid resuscitation. Methods From November 2005 to June 2009, 47 children with septic shock admitted to the Tung Wah Hospital Intensive Care Unit affiliated to Sun Yat-sen University were randomly divided into two groups. The concentrations of plasma colloid were dynamically monitored and fluid resuscitation was performed. A group of 22 cases, not colloid penetration measured value as a reference index, based on clinical experience fluid replacement, that is, rapid infusion stage with saline, continue and maintain liquid phase infusion solution: colloidal fluid is 2 ~ 3: 1. Group B, 25 cases, the dynamic monitoring of gel penetration concentration, such as less than normal, rapid infusion phase using more colloidal solution, continue and maintain the infusion phase using liquid crystal: colloidal solution is 1: 1, such as colloid permeation concentration is normal, deal with the same Group A The mean arterial pressure (MAP), hourly urine output, central venous pressure (CVP), volume of resuscitation fluid, amount of vasoactive drugs, pediatric critical illness score (PCIS score) and other indicators were recorded and statistically analyzed analysis. Results There was no significant difference in COP, PCIS score, MAP and CVP between the two groups when they were admitted to the hospital, and COP was significantly lower than the normal range. The dosage of colloid in group B was higher than that in group A at each time. The total amount of liquid used in group 6 and 24hB was less than that in group A, PCIS score, urine output per hour, MAP and CVP in groups 1 and 6hB were all greater than those in group A, and the amounts of all vasoactive drugs were less than those in group A. There was no significant difference in PCIS score, urine output per hour, MAP and CVP between the two groups at 24h, but the amount of vasoactive drugs in group B was less than that of group A. Conclusions The dynamic monitoring of COP in septic shock fluid resuscitation in children is based on adjusting the proportion of crystal colloid in the resuscitation solution, which can effectively improve the curative effect.