Résumé
Objective:To study the predictive value of vasoactive-inotropic score (VIS), fluid overload (FO) and lactate level for the outcome of preterm infants with refractory septic shock.Methods:Preterm infants diagnosed with refractory septic shock and required hydrocortisone treatment in our Department from January 2016 to December 2021 were analyzed retrospectively. Preterm infants were assigned into three gestational age groups (<28 weeks, 28-31 weeks, 32-36 weeks). According to the outcome of the disease, the children were further divided into good prognosis group and poor prognosis group. The relationship between the maximum VIS, FO and the mean lactic acid before hydrocortisone and the outcome of refractory septic shock was analyzed by receiver operating characteristic (ROC) curve, the cut-off point of ROC curve was calculated to obtain the predictive efficacy of the three indicators for the outcome of refractory septic shock in preterm infants.Results:A total of 50 preterm infants with refractory septic shock and received hydrocortisone treatment were enrolled, including 20 in the good prognosis group and 30 in the poor prognosis group. There were no significant differences in the maximum VIS, FO and mean lactic acid before hydrocortisone treatment between the two groups of gestational age of <32 weeks ( P> 0.05). The maximum VIS, FO and mean lactic acid of gestational age of 32-36 weeks in the poor prognosis group were higher than those in the good prognosis group, VIS: 56.1±15.7 vs. 37.1±12.9, FO (%): 108.2 (78.6,137.7) vs. 55.5 (10.3, 100.7), and mean lactic acid (mmol/L): 8.3 (4.6, 12.0) vs. 4.8 (-0.8, 10.5), all P<0.05. The area under the ROC curve of the mean lactic acid was the largest, the cut-off value was 4.1 mmol/L, and the Youden index was 1.732. Conclusions:VIS, FO and lactate level are difficult to be used for determining the outcome of refractory septic shock in preterm infants of <32 weeks. While the mean lactic acid has the best predictive performance in preterm infants of 32-36 weeks.
Résumé
Objective To observe the effect of acetated Ringer's solution or lactated Ringer's solution on intra-operative vital signs and blood gas analysis indexes in children (aged 1-6 years) undergoing tibia pseudoarthrosis orthopaedic operation. Methods Sixty-four children who underwent tibial pseudoarthrosis orthopaedic operation admitted to the Department of Anesthesiology of Hunan Children's Hospital from October 2016 to October 2018 were enrolled and anesthesia was performed by general anesthesia combined with epidural anesthesia, children were randomly divided into a sodium lactated Ringer's solution injection group (LR group) and a acetated Ringer's solution injection group (AR group), and different groups of children were treated with the corresponding crystal solution for intra-operative maintenance. The vital signs and results of blood gas analysis, etc of the two groups were compared at T1 (before the operation), T2 (2 hours after the beginning of operation) and T3 (at the end of operation). Results Finally, 22 patients in LR group and 28 patients in AR group had completed the study. The arterial partial pressure of carbondioxide (PaCO2), blood Na+, K+, Ca2+, glucose, hematocrit (HCT), bicarbonate (HCO3-), total hemoglobin (THb), etc laboratory indicators as well as vital signs of heart rate, systolic blood pressure, diastolic blood pressure, body temperature, etc. showed no statistically significant differences between the two groups at T1 (all P > 0.05). The lactate (Lac) levels at T2 and T3 in AR group were obviously lower than those in LR group (mmol/L: T2 was 1.01±0.21 vs. 1.42±0.47, T3 was 1.38±0.53 vs.2.07±0.48, both P < 0.05) , while pH, base excess (BE) and HCO3- were obviously higher in AR group [pH: T2 was 7.35±0.08 vs. 7.32±0.07, T3 was 7.33±0.06 vs. 7.28±0.03; BE (mmol/L): T2 was 1.02±0.18 vs. 0.67±0.45, T3 was 0.03±0.28 vs. -0.01±0.57; HCO3- (mmol/L): T2 was 21.28±1.20 vs. 20.10±0.17, T3 was 21.09±0.28 vs. 19.96±6.67, all P < 0.05]. Conclusion In the orthopaedic surgery of children's tibia pseudoarthrosis orthopaedic operation, acetated Ringer's solution not only can maintain water, electrolyte, acid-base balance and blood circulatory stabilities but also can reduce the increase of lactate level, which is conducive to maintaining the stability of the internal environment in the organism.