目的: 感染性休克是导致儿童心脏术后高死亡率的一个重要方面。本次研究的目的是介绍我们在
患儿心脏术后感染性休克方面的治疗经验。方法: 共756 例接受心脏手术的患儿，其中31 例( 4．0%) 患儿在我科
重症监护病房( ICU) 治疗期间发生感染性休克。患儿在ICU( 31 例中有15 例由于心肺功能不稳定，需要呼吸机
辅助通气治疗) 术后4～ 10d 被诊断为感染性休克。治疗方法包括: 采用液体复苏的方式，迅速输入胶体液( 15 ～
20mL/kg，30min) 并联合强心药物和升压素，7～ 14d 内经过血培养和临床效果选用敏感抗生素。结果: 首剂应用
多巴胺( 10μg /kg·min) 和多巴酚丁胺( 8 ～ 10μg /kg·min) ，然后输入肾上腺素或/和去甲肾上腺素( 0．05－0．25
μg /kg·min) 纠正低血压。本次研究中，31 名患儿应用此方法，26 例治愈出院，5 例在PICU 中死亡，死亡率为
16．1%。5 例死亡患儿中，2 例死于急性呼吸窘迫综合征，2 例死于多器官衰竭，1 例死于心力衰竭。结论: 感染性
休克可能会导致心脏术后患儿死亡率增加，如果感染性休克能得到及时的诊断和治疗，可以提高生存率。

Objective: Septic shock is a serious problem that can result in significant mortality in
children after opened heart surgery．The aim of our study was to report our experiences of management
in children with septic shock after opened heart surgery．Methods: Total of 756 patients with congenital
heart diseases after cardiac surgery was enrolled． 31 ( 4%) patients were diagnosed with septic shock
when they were in intensive care unit ( ICU) ． The septic shock was diagnosed in4 ～ 10days post
operation during stay in ICU( 15 /31need re－ventilated due to respiratory or heart function unstable) ．
The therapy included: administration of colloid fluid resuscitation( 15～20mL /kg in 30 min) as soon as
possible，combined inotropes /vasopressors，and a usual7～ 14days of antibiotic therapy guided by blood
culture and clinical response．Results: The hypotension remained since first utilized of dopamine( 10μg /
kg·min) and dobutamine( 8 ～ 10μg /kg·min) ， then epinephrine or /and norepnephrine( 0．05－0．25
μg /kg·min) was admitted to correct hypotension．In this group of study，31patients were administered
epinephrine or /and norepinephrine，26patients survived and discharged，5patients died during PICU
stay．The overall mortality rate was 16．1%．Among of 5 patients，2patients died due to ARDS，2died due
to multiple organ failure and 1 died due to heart failure．Conclusion: Septic shock may cause high mortality
in children after opened heart surgery．If septic shock be identified earlier and managed appropriately，
survival could be increased．

R725．4

 收稿日期: 2016－11－23; 修回日期: 2017－02－16
基金项目: 内蒙古自治区自然科学基金( 2016MS0830)
作者简介: 高荣( 1974－) ，男，内蒙古医科大学附属医院心脏大血管外科主任医师，教授，硕士研究生导师。