Correspondent Kan Nana Reporter Chen Tiantian
Recently, the emergency department, pediatric surgery, anesthesiology (operating room), pediatric critical care medicine department and other departments of the Affiliated Hospital of Binzhou Medical College have been closely Collaborated and successfully treated a child with gastric perforation and septic shock. Currently. The patient has recovered and been discharged from the hospital.
At 16:10 on April 28, Xinxin (pseudonym), a 12-year-old girl from Gaoqing County, was transferred to Binhai Hospital Affiliated Hospital because of abdominal pain for 2 days. At this time, Xinxin had abdominal pain, vomiting, and stopped gas and defecation for 2 days. The local examination results showed that the infection index was high. The abdominal CT examination showed: a large amount of ascites and pelvic effusion, gastric torsion. The child has poor spirits, low body temperature, fast heart rate, low blood pressure – shock.
Time is life! Physician Bu Naitong in the emergency department immediately gave emergency treatment, and at the same time asked for emergency pediatric surgery consultation. At 16:20, Geng Lei, deputy chief physician of the Department of Pediatrics, rushed to the emergency department to conduct a careful examination of the heart. Cardiac plate abdomen, whole abdominal tenderness, rebound tenderness, weak bowel sounds, very little urine output, blood gas analysis showed acidosis, septic shock, diffuse peritonitis! The child’s life is on the line, and surgical exploration is imminent! After communicating with the parents, Dr. Geng Lei immediately arranged emergency laparoscopic surgery for Xinxin.
Deputy chief physician Bu Xiangmei of the Department of Anesthesiology relayed shock rescue. At 19:21, the operation began. Anesthesiologist Zhu Yichao, the attending physician, stared at the child’s worrying blood pressure from time to time. He quickly gave fluid replacement, applied vasoactive drugs, corrected internal environment disorders, and rescued shock. At the moment of opening the abdominal cavity, a large amount of gas and dark brown turbid liquid overflowed, a large amount of food residues and a large amount of pus moss adhered in the abdominal cavity, and the intestinal tube and the omentum were widely adhered, which was a gastrointestinal perforation! The food residue was quickly removed and the abdominal cavity was washed repeatedly. Chief physician Fu Tingliang of the Pediatric Surgery Department carefully explored every part of the gastrointestinal tract and found that the fundus of the stomach was wrapped by the omentum with a size of about 2cm × 1cm, and there was 2cm of tissue necrosis around the perforation. : gastric perforation. The necrotic part was removed and the damaged stomach wall with a size of 6cm×4cm was repaired. The operation lasted 6 hours, and the operation ended at 2:20 am the next day.
After the operation, Xinxin was immediately transferred to the Pediatric Intensive Care Unit (PICU) for further rescue. The child had a rapid heart rate, low blood pressure with continuous arterial blood pressure monitoring, and low urine output. After receiving the consultation, Dr. Kan Nana continued to give volume expansion, albumin, plasma infusion, vasoactive drug boosting, and anti-shock therapy. At the same time, strengthen anti-infection and respiratory support treatment. There are symptoms of severe sepsis, septic shock, acute kidney injury, unstable blood pressure, systemic edema, oliguria, fever, and floccules in abdominal drainage fluid. Li Xiaomei, director of the PICU, immediately prepared continuous blood purification treatment for the child together with Wu Yanli, the deputy head nurse of the PICU, after communicating with her Xinxin mother. Attending physician Liu Xiaoming successfully completed ultrasound-guided femoral vein catheterization, filter preparation, tubing soaking, flushing, priming, connection, and blood drainage for PICU nurses. At 17:00 on April 29th, he was successfully boarded and the continuous venous hemofiltration (CVVH) treatment started. Close monitoring of vital signs at the bedside, dynamic assessment of electrolytes, coagulation, and blood gas analysis. After 26 hours, the plane was successfully disembarked.
All indicators of the heart and heart improved, inflammatory factors were significantly reduced, and the decreased white blood cells and lymphocytes also gradually recovered. The child’s vital signs gradually stabilized, the tissue edema subsided, but there was still repeated fever. Culture growth of ascites: Candida fermentum, according to the drug susceptibility results, add antifungal drugs. Finally, after several adventures, under the careful care of the PICU medical staff, the condition of the heart improved day by day, and the femoral vein catheter, urinary catheter, and tracheal intubation were gradually removed, and the ventilator was withdrawn. Xinxin began to show a sweet smile. She said that she would also become a pediatrician in the future to take care of children who were sick like her.
On May 11, he was transferred out of PICU and transferred to Pediatric Surgery for further consolidation treatment. On May 18, he recovered and was discharged from the hospital. The change of heart from danger to safety is due to the close cooperation of the medical staff of the Children’s Emergency and Critical Care Center of Binyi Hospital Affiliated Hospital, and the superb technology of the Children’s Emergency and Critical Care Center of Binyi Hospital Affiliated Hospital.
In the future, the Children’s Emergency and Critical Care Center of Binhai Hospital Affiliated Hospital will give full play to the core of the region To expand the scope of radiation, with excellent clinical, management team and advanced medical equipment, improve the ability of critically ill children in the region and surrounding areas, provide efficient and high-quality medical services for children and parents, and meet the health needs of children and parents .
Continuous blood purification therapy is the general term for all continuous, slow removal of water and solute therapy. The purpose of treatment is not limited to replacing the damaged kidneys, but also extends to the first aid of common critical illnesses, becoming one of the most important supportive measures in the treatment of various critical illnesses.
At present, the PICU of Binyi Hospital has carried out continuous blood purification treatment technology for children, which can be used for CRRT, plasma exchange, blood perfusion and other treatments. To achieve acute kidney injury complicated with severe electrolyte disturbance, MODS, septic shock, acid-base metabolism imbalance, heart failure, pulmonary edema, acute severe pancreatitis, drug or toxic poisoning, severe electrolyte and acid-base metabolism disturbance, tumor lysis syndrome and Blood purification treatment for critically ill children with autoimmune diseases.