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本文报告24名严重休克病儿,经常规治疗无效,而用多巴胺治疗好转,并对其效果和安全性进行分析。其中20名为先心病,18名休克发生在心脏术后,2名休克发生于严重的充血性心力衰竭。另4名为感染性疾病,3名为细菌性败血症,1名为病毒性脑炎。24名休克病儿均为心功能受累所致。休克的常规治疗包括呼吸的维持、纠正酸中毒、输血、输液、毛地黄和利尿剂的应用。无效后,用多巴胺治疗。常规治疗无效为血压、尿量、心率、中心静脉压或临床表现无改善。多巴胺的剂量,在血压正常但尿少者,开始给2微克/公斤/分,血压低者为5～10微克/公斤/分,以后剂量调整至维持血压和尿量,不产生过度的血管收缩或快速型心律失常。多巴胺的反应分成3组:(1)良好反应组:在收缩压稳定后增加15%以上,尿量亦增加,如多巴胺治疗开始前血压正常者,可见尿量增加,(2)无反应组:血压、尿量、心率、中心静脉压或临床表现无改善;(3)可疑反应组:血压改善但尿量无改善,或尿量改善但血压增加不足15%。结果:多巴胺治疗后血压和尿量显著增加,而中心静脉压或心率无显著变化。2名感染性疾病和7名
This article reports 24 severe shock sick children, the conventional treatment is ineffective, and with dopamine treatment improved, and its efficacy and safety analysis. Twenty of them were congenital heart disease, 18 were in cardiac surgery and two were in severe congestive heart failure. The other four were infectious diseases, three were bacterial sepsis and one was viral encephalitis. 24 shock sick children are due to cardiac dysfunction. Routine treatments for shock include the maintenance of respiration, the correction of acidosis, blood transfusions, transfusions, cough yellow and diuretics. After the invalid, with dopamine treatment. Routine treatment ineffective for blood pressure, urine output, heart rate, central venous pressure or no improvement in clinical manifestations. Dopamine dose, in the normal blood pressure but low urine, the beginning to 2 micrograms / kg / min, low blood pressure of 5 to 10 micrograms / kg / min, after the dose was adjusted to maintain blood pressure and urine output, does not produce excessive vasoconstriction Or tachyarrhythmia. The reaction of dopamine was divided into three groups: (1) good response group: the systolic blood pressure increased more than 15%, urine output also increased, such as normal blood pressure before dopamine treatment, showing increased urine output, (2) no reaction group: Blood pressure, urine output, heart rate, central venous pressure or no improvement in clinical manifestations; (3) Suspicious reaction group: no improvement in blood pressure, or improvement in urine output, but blood pressure increased by less than 15%. Results: After dopamine treatment, blood pressure and urine output increased significantly, while central venous pressure or heart rate did not change significantly. 2 infectious diseases and 7