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目的 :探讨糖皮质激素联合目标液体复苏对脓毒症休克患儿组织灌注、免疫功能及乳酸清除率的影响。方法 :选取符合纳入条件的80例脓毒症休克患儿,随机均分为对照组与观察组每组40例,对照组采用目标液体复苏治疗,观察组在对照组基础上加用糖皮质激素治疗,比较两组患儿治疗前后临床症状改善情况,测定乳酸清除率、组织灌注指标及免疫功能的改善情况。结果 :(1)治疗后,两组MAP、CVP、尿量、Scv O2上升,与治疗前对比差异有统计学意义,观察组各指标上升幅度高于对照组;(2)治疗6h、1d、3d、1周,两组血乳酸水平均降低,乳酸清除率上升,与治疗前对比差异有统计学意义,观察组治疗后不同时间点乳酸降低幅度高于对照组,乳酸清除率高于对照组;(3)治疗后,两组APACHEⅡ评分、SOFA评分均降低,观察组不同时间点评分降低幅度均高于对照组;(4)观察组治疗后CD3+、CD4+、CD8+均高于对照组。结论 :采用糖皮质激素联合目标液体复苏治疗脓毒症休克患儿,可降低患儿血乳酸水平,提高乳酸清除率,改善其组织灌注状况,提高机体免疫功能。
Objective: To investigate the effect of glucocorticoid combined with target fluid resuscitation on tissue perfusion, immune function and lactic acid clearance in septic shock children. Methods: A total of 80 infants with septic shock who were eligible for inclusion were randomly divided into control group and observation group, 40 cases in each group. The control group was treated with target fluid resuscitation. The observation group was given glucocorticoid The clinical symptoms before and after treatment were compared between the two groups. The lactic acid clearance rate, perfusion index and the improvement of immune function were measured. Results: (1) MAP, CVP, urine volume and Scv O2 increased in both groups after treatment, the difference was statistically significant compared with that before treatment, and the increase rate of each index in the observation group was higher than that in the control group; (2) After 6h, 3d and 1 week, blood lactic acid levels decreased and lactic acid clearance increased, the difference was statistically significant compared with that before treatment. The decrease rate of lactic acid in observation group was higher than that in control group at different time points after treatment, the lactic acid clearance rate was higher than that in control group ; (3) After treatment, APACHEⅡscore and SOFA scores decreased in both groups, and the decrease of score in observation group at different time points was higher than that in control group. (4) CD3 +, CD4 + and CD8 + in observation group were higher than those in control group after treatment. Conclusion: The treatment of septic shock with glucocorticoid combined with target liquid resuscitation can reduce the level of lactic acid in children, increase the lactic acid clearance, improve the tissue perfusion and improve the immune function.