PICU, University hospital of Lille, France.
Acta Paediatr. 2012 Sep;101(9):e426-30. doi: 10.1111/j.1651-2227.2012.02725.x. Epub 2012 May 28.
To report our 10 year experience with noradrenaline use in children with septic shock focusing on doses, routes of administration and complications.
Retrospective single-centre review of children with septic shock who received noradrenaline between 2000 and 2010.
We identified 144 children with septic shock treated with noradrenaline, in 22% as the first-line drug. The median volume resuscitation before vasoactive agent administration was 50 mL/kg interquartile range [IQR: 30-70]. Mean doses of noradrenaline ranged from 0.5 ± 0.4 μg/kg per min (starting dose) to 2.5 ± 2.2 μg/kg per min (maximum dose). Noradrenaline was administered via peripheral venous access or intra-osseous route in 19% of cases for a median duration of 3 h [IQR: 2-4] without any adverse effects. The use of noradrenaline increased over the study period. Mortality rate was 45% with a significant decrease over the study period. Adverse effects included arrhythmia in two children and hypertension in eight children. None of these arrhythmias required treatment and hypertension resolved with the noradrenaline dose reduction.
Higher doses of noradrenaline than those suggested in the literature may be necessary to reverse hypotension and hypoperfusion. The use of noradrenaline through peripheral venous access or intra-osseous route was safe, without any adverse effects.
报告我们在儿童感染性休克中使用去甲肾上腺素的 10 年经验，重点关注剂量、给药途径和并发症。
回顾性分析 2000 年至 2010 年间接受去甲肾上腺素治疗的感染性休克儿童的单中心研究。
我们共发现 144 例接受去甲肾上腺素治疗的感染性休克儿童，其中 22%的患儿将去甲肾上腺素作为一线药物。血管活性药物治疗前的中位容量复苏量为 50 mL/kg（四分位距[IQR]：30-70）。去甲肾上腺素的平均剂量范围为 0.5±0.4 μg/kg/min（起始剂量）至 2.5±2.2 μg/kg/min（最大剂量）。去甲肾上腺素通过外周静脉或骨髓途径给药的比例分别为 19%，中位持续时间为 3 h（IQR：2-4），无任何不良反应。去甲肾上腺素的使用在研究期间有所增加。死亡率为 45%，且随着研究时间的推移呈显著下降趋势。不良反应包括两名儿童出现心律失常，八名儿童出现高血压。这些心律失常均无需治疗，且去甲肾上腺素剂量减少后高血压得到缓解。
为逆转低血压和低灌注，可能需要比文献中建议更高剂量的去甲肾上腺素。外周静脉或骨髓途径使用去甲肾上腺素是安全的，没有任何不良反应。
