小儿肾病综合征伴发低血容量休克56例临床回顾剖析.docVIP

小儿肾病综合征伴发低血容量休克56例临床回顾剖析 　　【中图分类号】R692【文献标识码】A【文章编号】1005-2720(2009)03-0011-04 　　【摘要】目的：分析小儿肾病综合征伴发低血容量休克的症状、体征、实验室检查和治疗方法。方法：对1996～2007年间共诊治的56例肾病综合征伴发低血容量休克患儿的临床资料进行回顾性分析。结果：56例小儿肾病综合征休克发生前有20例应用过呋塞米；腹泻20例，呕吐14例；激素：突然减量10例，自行停药6例；并发感染10例。休克出现时安静状态下心率均120次/min，其中160次/min 26例，200次/min 8例。血常规Hb14～16g/L者32例，16～19g/L者24例。红细胞比容(Hct)0.45～0.48者24例，0.48～0.54者26例。给予扩容等抗休克积极治疗，全部病例均治愈。结论：对小儿肾病综合征病患儿易患低血容量休克应有充分认识，特别是有吐泻、利尿及激素减停药时。临床早期诊断低血容量休克较可靠的客观指标：①当安静时心率120次/min，除外其他因素，常提示血容量的不足；160次/min时，应特别注意是否有休克的体征。心率增快是早期低血容量休克时出现的主要症状。②当血常规Hb值15g/L，Hct0.45时，提示有低血容量出现；Hct0.50时，多可寻及休克体征。本症一经诊断，即应积极扩容等抗休克治疗。 　　【关键词】肾病综合征；低血容量休克；儿童 　　 　　Clinical analysis of 56 cases of nephrotic syndrome in children with hypovolemic shock.Yan Zhixian，Mo Weixiong，Zhang Weichang，Yu Jianli，Feng Shuirong.(The first people’s hospital of Zhaoqing，Guangdong 526021) 　　【Abstract】Objective：To analyze the symptoms，signs，laboratory examination and treatment of nephrotic syndrome in children with hypovolemic shock.Methods：The clinical data of 56 cases of nephritic syndrome in children with hypovolemic shock from 1996 to 2007 were analyzed retrospectively.Results：20 cases of nephritic syndrome used furosemide before shock；the clinical symptoms including： diarrhoea in 20 cases and vomiting in 14 cases；hormone reduction in 10 cases，hormone stopped in 6 cases and complicated infection in 10 cases.The resting heart rate of all children was more than 120 beats/min during shock，over 160 beats/min in 26 cases and over 200 beats/min in 8 cases among them.The blood routine showed Hb 14～16g/L in 32 cases and 16～19 g/L in 24 cases；hematocrit (Hct) 0.45～0.48 in 24 cases and 0.48～0.54 in 26 cases.All children received expansion and antishock treatment；all patients were cured.Conclusion：The hypovolemic shock easily occurs in nephritic syndrome in children，especially vomiting，diuresis and hormone reduction or stopped.The clinically early diagnostic index：①When the resting heart rate is above 120 beats/min，which suggests hypo