Crit Care Med:液体复苏对提高重症脓毒症患儿预后有影响吗?

2017-06-20 MedSci MedSci原创

为评估液体复苏是否对重症脓毒症患儿预后是否改善,本研究采取前瞻性观察研究方法对数量较大的官方数据库进行研究。

为评估液体复苏是否对重症脓毒症患儿预后是否改善,本研究采取前瞻性观察研究方法对数量较大的官方数据库进行研究。研究对象为分别来自于43家儿童医院的PICU的已诊断为重症脓毒症的患儿。

我们研究了从2004年至2012年间收录在儿童健康信息系统库中的患儿数据。对在发病后首个24小时和72小时内接受液体复苏治疗的重症脓毒症患儿和未接受液体复苏治疗的患儿进行比对,36908名符合标准的患儿被纳入分析。2398名患儿在第一个24小时内接受有针对性的液体复苏,1641名患儿在72小时内接受。在趋势匹配后发现,与未接受液体复苏患儿相比,72小时接受液体复苏组死亡率更低(12.5% vs 15.9%;p=0.007;odds ratio,0.76;95% Cl,0.62-0.93),急性肾功能衰竭发生率更低(16.0% vs 19.2%,p=8;odds ratio,0.82;95% Cl,0.68-0.98),血管活性药物使用天数更少(3.0 vs 3.3;p<0.001)。

综上所述得出结论:在此回顾性分析实施中采用趋势匹配,和未使用液体复苏组的严重脓毒症患儿相比较,72小时内使用液体复苏的患儿生存率得以提高,急性肾功能衰竭发生率下降,使用血管活性药物时间缩短。

原始出处:

Emrath ET1, Fortenberry JD, Travers C,et al.Resuscitation With Balanced Fluids Is Associated With Improved Survival in Pediatric Severe Sepsis. Crit Care Med. 2017 Jul;45(7):1177-1183. doi: 10.1097/CCM.0000000000002365.

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