摘要目的:探讨初始血流动力学评估对新生儿休克的诊疗价值。方法:选取2020年1月至2023年12月广东省妇幼保健院新生儿重症监护病房收治的休克患儿进行回顾性研究，根据使用血管活性药物前是否进行血流动力学评估分为评估组和非评估组，比较两组患儿的临床资料、血管活性药物使用情况及治疗结局。在评估组中，比较足月儿与早产儿血管活性药物的使用情况。结果:共纳入300例休克患儿，评估组200例，非评估组100例。与非评估组相比，评估组首选多巴酚丁胺（34.5%比22.0%）、肾上腺素（8.5%比2.0%）、去甲肾上腺素（19.5%比7.0%）的比例明显升高，首选多巴胺（36.5%比68.0%）的比例明显下降，病程中多巴酚丁胺的使用剂量比非评估组明显升高［10.0（5.0，10.0）μg/（kg·min）比7.3（5.0，10.0）μg/（kg·min）］，休克病死率明显降低（8.0%比20.0%），差异均有统计学意义（ P<0.05）；评估组患儿出院前死亡率、Ⅲ~Ⅳ级脑室内出血发生率低于非评估组，但差异无统计学意义（ P>0.05）。200例评估组患儿中，足月儿59例，早产儿141例；足月儿接受去甲肾上腺素治疗的比例明显高于早产儿（81.4%比65.2%， P<0.05），两组其他血管活性药物使用情况的差异均无统计学意义（ P>0.05）。 结论:在新生儿休克管理中应用血流动力学评估选择合适的血管活性药物，可快速恢复组织器官的血流灌注，降低患儿的病死率和Ⅲ~Ⅳ级脑室内出血发生率。

abstractsObjective:This study aims to investigate the value of initial hemodynamic assessment for neonatal shock management.Methods:Clinical data of neonates with shock admitted to the Neonatal Department of Guangdong Women and Children Hospital from January 2020 to December 2023 were retrospectively reviewed. The neonates were assigned to evaluation group or non-evaluation group based on the hemodynamic assessment execution status prior to vasoactive medication administration. Clinical data, utilization of vasoactive drugs and outcomes were compared between the two groups. In the evaluation group, we also compared the vasoactive drugs use of premature infants with that in term infants.Results:A total of 300 neonates were enrolled, including 200 in evaluation group, 100 in non-evaluation group. In comparison to the non-evaluation group, the evaluation group exhibited a higher usage rate of dobutamine (34.5% vs. 22.0%, P=0.033), epinephrine (8.5% vs. 2.0%, P=0.041), and norepinephrine (NE) (19.5% vs. 7.0%, P=0.006), whereas dopamine (36.5% vs. 68.0%, P<0.001) was used utilized less frequently. Dobutamine doses [10.0 (5.0,10.0) μg/(kg·min) vs. 7.3 (5.0,10.0) μg/(kg·min), P=0.025] were significantly higher in the evaluation group. The mortality of the evaluation group was significantly lower than that of the non-evaluation group (8.0% vs. 20.0%, P=0.004). Though insiginificant, there were trends of decreased pre-discharge mortality and grade Ⅲ-Ⅳ intraventricular hemorrhage in the evaluation group ( P>0.05). Among the 59 term and 141 preterm infants included in the evaluation group, higher proportion of term infants were treated with NE (81.4% vs. 65.2%, P=0.028). Conclusions:The utilization of hemodynamic assessment in the management of neonatal shock, combined with the appropriate selection of vasoactive drugs, promotes rapid recovery of organ perfusion and improves the prognosis of patients.