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目的分析小儿心源性休克(CS)的临床特点和预后。方法2002年1月至2005年12月本院PICU收治的非心脏病近期手术所致CS患儿19例。回顾分析临床表现、心电图、胸片、超声心动图特点及与预后的关系。结果小儿CS临床表现以呼吸道、消化道症状为主,缺乏特异性。病死率68.4%,其中61.5%死于入院24h内,平均死亡时间为入院后31.5h。死亡的原发病为心肌炎(58例),先心病(56例),心肌病(22)和感染性心内膜炎(11)。直接死亡原因分别是心脏泵功能衰竭、心律失常各4例,心脏泵功能衰竭与心律失常共同作用5例。超声心动图的血流动力学参数LVEF、SVI、LVEDVI、LVESVI、CI在生存者和死亡者之间差异无显著性(P>0.05)。并发DIC及心跳呼吸骤停的病死率分别是100%及75%。肝、肾功能异常,代谢性酸中毒的严重度与病死率无关。结论小儿CS病死率高,尤其在CS早期,并发DIC及心跳呼吸骤停者预后更差。致死的主要原因是心肌炎、心肌病、先心病等原发病导致心脏泵功能衰竭或和心律失常。超声心动图对原发病的诊断起十分重要的作用,应早期常规检查,但其血流动力学变化不能作为判断预后的指标。传统治疗方法效果不佳,在国内应尽快采用VAD、BiVAD、ECMO等技术救治暴发性心肌炎所致CS,以挽救患儿生命。
Objective To analyze the clinical characteristics and prognosis of pediatric cardiogenic shock (CS). Methods From January 2002 to December 2005, 19 children with CS who were treated by recent noncardiac surgery underwent PICU in our hospital. Retrospective analysis of clinical manifestations, electrocardiogram, chest X-ray, echocardiographic features and prognosis. The results of pediatric CS clinical manifestations of respiratory tract, gastrointestinal symptoms, the lack of specificity. The mortality rate was 68.4%, of which 61.5% died within 24 hours after admission. The average death time was 31.5 hours after admission. The primary deaths were myocarditis (58), congenital heart disease (56), cardiomyopathy (22) and infective endocarditis (11). The direct causes of death were cardiac pump failure, arrhythmia in 4 cases, cardiac pump failure and arrhythmia in 5 cases. Echocardiography hemodynamic parameters LVEF, SVI, LVEDVI, LVESVI, CI no significant difference between survivors and deaths (P> 0.05). Complications of DIC and cardiac arrest were 100% and 75%, respectively. Liver and kidney dysfunction, the severity of metabolic acidosis has nothing to do with mortality. Conclusion The high mortality rate of children with CS, especially in the early stage of CS, the prognosis of patients with concurrent DIC and cardiac arrest is worse. The main cause of death is myocarditis, cardiomyopathy, congenital heart disease and other primary diseases lead to heart pump failure or arrhythmia. Echocardiography plays a very important role in the diagnosis of primary disease and should be routinely checked early, but its hemodynamic changes can not be used as an indicator of prognosis. Traditional treatment ineffective, as soon as possible in the country using VAD, BiVAD, ECMO and other technologies to treat CS due to fulminant myocarditis, in order to save children’s lives.