关键词: 脓毒性休克； 脑氧饱和度； 脑血流参数； 预后

Abstract: Objective To explore the value of cerebral oxygen saturation (rScO2 ) and cerebral blood flow parameters including oxygenated hemoglobin concentration (ΔO2Hb), reduced hemoglobin concentration change (ΔHHb) and hemoglobin concentration index (THI) in indicating the prognosis of septic shock in children. Methods A total of 50 children with septic shock admitted from October 2017 to October 2019 were selected. Hemodynamic parameters including mean arterial pressure (MAP), central venous pressure (CVP), central venous oxygen saturation (ScvO2 ) and blood lactic acid were monitored immediately after admission to the intensive care unit (ICU). Cerebral oxygen parameters including rScO2 , ΔO2Hb, ΔHHb and THI were also monitored. According to the prognosis at 28 days after admission to ICU, the children were divided into survival group and death group. Cerebral blood oxygen and hemodynamic parameters of the two groups were analyzed. Results In 50 children ( 31 boys and 19 girls) at median age of 4 years with septic shock, there were 30 children in the survival group and 20 children in the death group. Acute Physiology And Chronic Health Evaluations (APACHE) Ⅱ score and Sepsis-related Organ Failure Assessment (SOFA) score in death group were significantly higher than those in survival group, and the differences were statistically significant (P< 0 . 05 ). The levels of MAP, CVP and ScvO2 in the death group were significantly lower than those in the survival group after 6 hours of initial resuscitation, and the differences were statistically significant (P the death group was statistically significant (P< 0 . 05 ), and all indexes showed an upward trend. After the initial resuscitation treatment, the rScO2 and THI of the survival group increased rapidly over time, which were significantly higher than those in the death group (P< 0 . 05 ). After 6 hours of treatment, rScO2 and ΔO2Hb were positively correlated with ScvO2 (P< 0 . 05 ), while THI was negatively correlated with blood lactic acid level (P< 0 . 05 ). The AUC of rScO2 , ΔO2Hb, ΔHHb and THI in predicting the prognosis of septic shock in children were 0 . 765 , 0 . 642 , 0 . 608 and 0 . 718 , respectively. Conclusions The early cerebral blood oxygen parameters (rScO2 , ΔO2Hb, ΔHHb and THI) monitored by near infrared reflectance spectroscopy have certain diagnostic values for the prognosis of children with septic shock.

Key words: septic shock; cerebral oxygen saturation; cerebral blood flow parameter; prognosis