Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Indian J Pediatr. 2011 Jun;78(6):726-33. doi: 10.1007/s12098-011-0415-z. Epub 2011 May 4.
Septic shock is an important cause of mortality in children with sepsis. The incidence of septic shock is 2-4% of admissions in western pediatric intensive care units and 40%-67% for Indian PICUs. Early goal-directed resuscitation that includes aggressive fluid resuscitation of up to 60 mL/kg as boluses of 20 mL/kg by IV push, to achieve desired heart rates and blood pressure, has emerged as mainstay of treatment in the initial stage. Crystalloids are the preferred fluids, while colloids may be used in some situations. Fluid refractory shock warrants use of vasoactive drugs. Dopamine is the first choice. Dobutamine and low dose epinephrine are the preferred inotropic drugs while nor-epinephrine is a vasopressor. Children with cold shock and normal blood pressure may benefit from nitrosodilators like nitroprusside and nitroglycerine. Inodilators such as milrinone are also useful in this situation. Targeting clinical therapeutic end-points assists the management. Good supportive care is also essential for improving the outcomes.
感染性休克是儿童脓毒症死亡的重要原因。在西方儿科重症监护病房，感染性休克的发病率为入院患儿的 2-4%，而在印度儿科重症监护病房则为 40%-67%。早期目标导向复苏，包括积极的液体复苏，给予 20 毫升/公斤的静脉推注，高达 60 毫升/公斤的推注，以达到所需的心率和血压，已成为初始治疗的主要方法。晶体液是首选的液体，而胶体液在某些情况下可能会被使用。液体难治性休克需要使用血管活性药物。多巴胺是首选药物。多巴酚丁胺和小剂量肾上腺素是首选的正性肌力药物，而去甲肾上腺素是血管加压药。对于冷休克和血压正常的患儿，硝普钠和硝酸甘油等硝酸酯类药物可能有益。米力农等血管扩张剂在这种情况下也很有用。针对临床治疗终点有助于治疗管理。良好的支持性护理对于改善预后也至关重要。
