论文部分内容阅读
目的探讨小儿心源性休克的临床特点、治疗及预后相关因素。方法对36例心源性休克患儿进行回顾性分析。结果起病症状因年龄、原发病不同而异。不同原发病休克出现时间不同,阵发性室上性心动过速(PST)为(62.2±12.9)h,心肌病(CMP)为(42.0±23.0)h,心内膜弹力纤维增生症(ECF)为(20.3±11.1)h,暴发性心肌炎(FMC)为(15.0±7.8)h。休克早期均有心音低钝,15例(41.6%)伴奔马律,17例(47.2%)需心肺复苏。所有病例心脏超声测定射血分数(ejectionfraction,EF)、短轴缩短分数(fractionalshortening,FS)均下降,分别为(0.32±0.11)、(0.14±0.05)。35例(97.2%)有心胸比例增大(0.74±0.04),34例(94.4%)合并心律失常。入院治疗后休克持续时间为预后相关因素(P=0.002,Wald=9.91)。液体复苏在严密监测下进行,ECF、FMC、CMP复苏液量分别为5.25ml·kg-1·h-1、4.48ml·kg-1·h-1、4.75ml·kg-1·h-1。结论小儿心源性休克临床表现多样,病情凶险。早期做床边心脏超声、胸片、心电图检查有助诊断。治疗后休克持续时间为判断预后的指标。治疗除针对原发因素外,液体复苏亦有其特殊性。
Objective To investigate the clinical features, treatment and prognosis of pediatric cardiogenic shock. Methods 36 children with cardiogenic shock were retrospectively analyzed. Results onset symptoms due to age, primary disease varies. Different primary shock onset time, paroxysmal supraventricular tachycardia (PST) was (62.2 ± 12.9) h, cardiomyopathy (42.0 ± 23.0) h, endocardial fibroelastosis ( ECF) was (20.3 ± 11.1) h, and fulminant myocarditis (FMC) was (15.0 ± 7.8) h. In the early stage of shock, heart sounds were low and blunted, 15 cases (41.6%) with gallop and 17 cases (47.2%) required cardiopulmonary resuscitation. The ejection fraction (EF) and fractional shortening (FS) of all patients underwent echocardiography decreased (0.32 ± 0.11) and (0.14 ± 0.05), respectively. Thirty-five patients (97.2%) had an increased ratio of heart and chest (0.74 ± 0.04) and 34 patients (94.4%) had arrhythmia. The duration of shock after admission was prognostic factor (P = 0.002, Wald = 9.91). Liquid resuscitation was performed under close monitoring. The volume of resuscitation fluid for ECF, FMC and CMP were 5.25ml · kg-1 · h-1, 4.48ml · kg-1 · h-1 and 4.75ml · kg-1 · h-1, respectively . Conclusion The clinical manifestations of pediatric cardiogenic shock are diverse and dangerous. Early bedside ultrasound, chest X-ray, ECG helps diagnose. The duration of shock after treatment is an indicator of prognosis. In addition to treatment for the primary factors, liquid resuscitation also has its particularity.