目的 评估重症超声与无创心排出量监测（noninvasive cardiac output monitoring, NICOM）在指导新生儿脓毒性休克液体复苏中的应用效果。通过动态监测休克患儿对液体治疗的反应性，比较上述两种方法在新生儿液体复苏中的治疗效果及临床适用价值。 方法 共纳入51例患儿，在开始液体复苏前被随机分配到接受重症超声或NICOM指导液体复苏治疗组。分析比较两组患儿发生脓毒性休克后14 d内的病死率和其他临床结局之间的差异。 结果 两组患儿14 d内的病死率差异无统计学意义（P>0.05）。NICOM组血管活性药物累积使用时间较重症超声组短（P<0.05），同时在NICOM指导液体复苏下的患儿在72 h内发生急性肾损伤、颅内出血的风险均较重症超声组降低（均P<0.05）。但重症超声组患儿有创机械通气时间较NICOM组短（P<0.05），同时72 h内肺水肿的发生率也较NICOM组低（P<0.05）。然而，两组住院时间、达到乳酸<2 mmol/L时间、心功能损害、肝功能损害的患儿比例差异无统计学意义（均P>0.05）。 结论 NICOM指导下脓毒性休克患儿72 h内肾损伤及颅内出血的发生风险均低于重症超声组，而重症超声指导液体复苏可以减少患儿肺水肿的发生风险。重症超声和NICOM这两种简单、低成本、无创的临床工具均可以用来辅助指导新生儿脓毒性休克的液体复苏治疗。
Objective To evaluate the effectiveness of critical care ultrasound and noninvasive cardiac output monitoring (NICOM) in guiding fluid resuscitation in neonatal septic shock by dynamically assessing responsiveness to fluid therapy and comparing treatment outcomes and clinical applicability. Methods A total of 51 neonates were enrolled. Before initiation of fluid resuscitation, patients were randomly assigned to receive fluid resuscitation guided by critical care ultrasound or by NICOM. Differences in 14-day mortality and other clinical outcomes after the onset of septic shock were compared between the two groups. Results No significant difference was found in 14-day mortality between the critical care ultrasound group and the NICOM group (P>0.05). The cumulative duration of vasoactive drug use was shorter in the NICOM group than in the critical care ultrasound group (P<0.05). The incidences of acute kidney injury and intracranial hemorrhage within 72 hours in the NICOM group were lower than in the critical care ultrasound group (both P<0.05). However, the duration of invasive mechanical ventilation was shorter in the critical care ultrasound group than in the NICOM group (P<0.05), and the incidence of pulmonary edema within 72 hour was lower (P<0.05). No significant differences were observed between the two groups in length of hospital stay, time to achieve lactate <2 mmol/L, or the incidences of cardiac dysfunction and hepatic dysfunction (all P>0.05). Conclusions In neonates with septic shock, the risks of acute kidney injury and intracranial hemorrhage within 72 hours are lower under NICOM guidance than with critical care ultrasound, whereas fluid resuscitation guided by critical care ultrasound reduces the risk of pulmonary edema. Both critical care ultrasound and NICOM are simple, low-cost, noninvasive tools that can assist in guiding fluid resuscitation in neonatal septic shock.
PDF(579 KB)
