- 期刊
Hypovolemia and Hypovolemic Shock in Children with Nephrotic Syndrome
腎病症候群兒童之低血容及低血容性休克
摘要
低血容於腎病症候群並非罕見之表現，然而，在文獻上不常被提及。本研究回溯自1983至1996年，共225個病人計328人次因腎病症候群急性發作之小兒科住院次數，分析其低血容性休克於急性腎病症候群發生率，以及血液濃縮與腹痛於低血容狀態之相關性。在十三個病人中，共計有十九次低血容休克發生，佔全部急性腎病症候群發作之5.8個百分點，而且併發有較嚴重的血液濃縮（血紅素19.6±2.2g/dL）與低血鈉(127.3±7.2mEq/L)現象。其他三十三人之四十一次無休克之低血容性發作共佔有12.5個百分點，亦併有相較於無低血容症狀病人高之血紅素值。在有腹痛及血液濃縮之61個住院人次中，有58人次對白蛋白注射反應良好，顯示這些病人表現了低血容症狀。在有腹痛而無血液濃縮之20個住院人次中，十八個人次被發現合併有原發性腹膜炎。結論爲在腎病症候群急性發作時之低血容，常伴隨有血液濃縮及腹痛；而血紅素與血鈉值是研判是否發生低血容休克之良好指標。在處理並有腹痛之腎病症候群急性發作病人時，需針對低血容休克與原發性腹膜炎做仔細的鑑別診斷。
並列摘要
Hypovolemic shock is not an uncommon presentation in nephrotic syndrome, yet it is seldem mentioned in the literature. This study was performed to investigate the prevalence of hypovolemia and hypovolemic shock in the acute nephrotic stage, and the association of hemoconcentration and abdominal pain with hypovolemic status. Two hundred and twenty-five patients with a total of 328 admissions to the pediatric ward of our hospital during 1983 to 1996 were retrospectively reviewed for hypovolemic episodes. Clinical presentation and laboratory data including hemoglobin, serum sodium, albumin, cholesterol, and triglyceride levels were investigated. Thirteen patients with 19 episodes (5.8%) of hypovolemic shock were found, and had more severe hemoconcentration (hemoglobin 19.6±2.2g/dL) and hvponatremia (127.3±7.2mEq/L). Another 33 patients with 41 symptomatic hypovolemic episodes without hypotension (12.5%) were found, and their hemoglobin levels were higher compared to patients without hypovolemic symptoms. Among 61 episodes of abdominal pain and hemoconcentration, 58 were responsive to albumin infusion. This suggested the presence of hypovolemia. Twenty patients had abdominal pain without hemoconcentration, and 18 of them had primary peritonitis. Hypovolemia was found in patients at the acute nephrotic stage, and was usually associated with hemoconcentration and abdominal pain. A combined examination of hemoglobin and serum sodium is the best indicator of hypovolemic status. Both primary peritonitis and hypovolemic episodes should be taken into consideration when managing abdominal pain in children with nephrotic syndrome.