Comparative Study Of Saline Versus Balanced Crystalloids For Septic Shock Fluid Resuscitation In Children

Objective: To observe the clinical results of saline versus Sodium Lactate Ringer Injection for septic shock fluid resuscitation in children.Methods: A prospective randomized controlled method was used to select 35 children with septic shock who were admitted to the Pediatric Intensive Care Unit(PICU)of Shengjing Hospital Affiliated to China Medical University from December 2018 to February 2020,and were divided into normal saline using random number tables Group(NS group)and sodium lactate Ringer's solution group(LR group).After entering the group,the first dose of crystalloids was 10-20 ml / kg intravenously,and the maximum dose of crystalloids within 1 hour was 60 ml / kg.Then evaluate the children repeatedly,adjust the speed and dose of resuscitation fluid according to the children's response to fluid resuscitation.If it is still ineffective or there is capillary leakage,albumin can be infused.PH,lactic acid,serum ions(Na+,K+,Cl-,Ca2+)and serum creatinine were measured at 0 and 24 hours of fluid resuscitation.Children's age,sex,weight,mechanical ventilation,blood culture results,pediatric risk of mortality ? score(PRISM?),and multiple organ dysfunction syndrome score were recorded.Fluid volume required for fluid resuscitation,colloid usage,incidence of acute kidney injury(AKI),continuous renal replacement therapy(CRRT)usage,and length of hospitalization were recorded.Results: A total of 35 children met the diagnostic criteria for septic shock during the study period.Patients who died within 24 hours of admission(including 2 in the NS group and 2 in the LR group)were excluded.Finally,31 patients were included in the analysis,including 19 in the NS group and 12 in the LR group.Seven patients(36.84%)died in the saline group,and 12 patients improved and were discharged,while 12 patients in the balanced crystalloids group improved and were discharged,the difference was statistically significant(P=0.026).Acute kidney injury was significantly associated with increased chloride(RR=1.371,95% Cl 1.025-1.836,P=0.034).Conclusion: In fluid resuscitation in children with septic shock,compared with sodium lactate Ringer injection,the mortality rate in the saline group was higher;increased chloride was more likely to cause acute kidney injury.