Pediatric hemorrhagic shock and encephalopathy syndrome
Introduction
Introduction to children with hemorrhagic shock and encephalopathy syndrome Hemorrhagic shock and encephalopathy syndrome (HSES) is a new clinical syndrome that has been recognized in recent years. Its main features are sudden onset of acute encephalopathy, coma, convulsions, high fever, watery diarrhea, and severe bleeding. A group of syndromes with propensity and disseminated intravascular coagulation (DIC) with liver and kidney dysfunction. basic knowledge The proportion of illness: 0.002% Susceptible people: young children Mode of infection: non-infectious Complications: diffuse intravascular coagulation
Cause
Pediatric hemorrhagic shock and etiology of encephalopathy syndrome
Cause:
The cause of this disease is unknown.
Pathogenesis
Although some people think that this symptom is only a special form of heatstroke in infants, in recent years, more scholars have supported the view that HSES is a new syndrome. It cannot be proved by extensive bacterial and virological studies. Infection-related, most scholars believe that it is related to heat retention. Whittington believes that the stability of heat is mainly maintained by the precise balance of heat load and heat dissipation in the human body. The heat load is the sum of environmental heat and metabolic heat, and the baby's sweat and heat dissipation. The regulation of heat is far less than that of adults. In the same thermal environment, infant sweating is about twice as high as that of adults. Adults and older children can automatically open their covers if they are overheated during sleep. To dissipate calories, and small babies often do not have the ability to cause body temperature to diverge, sweating a lot, dehydration to reduce effective circulation, shock, and even serious damage, high fever, shock to the brain, kidney, liver, pancreas and other organs Serious damage.
Prevention
Hemorrhagic shock and prevention of encephalopathy syndrome in children
Prevent small babies from overheating during sleep and cause overheating. In the hot summer, try to reduce the number of children in the hot sun or in poorly ventilated places; do not wear thick and poorly ventilated clothes; Salty salt water, and use ventilation equipment to keep the skin cool; for primary and secondary school students who participate in agricultural labor under the hot heat, it is necessary to arrange labor time reasonably, wear straw hat when working, and supply cold salt water or mung bean soup in time; find that the child has heatstroke In the case of aura, it should be allowed to leave the scene quickly; for children with a history of heat syndrome, move to a more shady area in the summer.
Complication
Hemorrhagic shock in children and complications of encephalopathy syndrome Complications, diffuse intravascular coagulation and blood in the stool
High fever, shock to the brain, kidney, liver, pancreas and other organs of serious damage, resulting in convulsions, denervation, leaving the sequela of the nervous system, can occur diffuse intravascular coagulation, clinical blood in the stool, pulmonary hemorrhage.
Symptom
Children with hemorrhagic shock and encephalopathy syndrome symptoms Common symptoms convulsions pulse is weak or even not... Coma convulsions fever accompanied by abdominal pain, ... shock water sample
1. The age of onset is mostly 3-8 months of infants. Of the cases reported in the literature so far, only 2 cases are full-term children of 14 months and 26 months.
2. Sudden onset: Most of the children are healthy children before the onset of illness. When they fall asleep at night, everything is normal, and often happens suddenly in the morning.
3. High fever and super high fever: body temperature can reach 40-45 °C of anal temperature, and even anal temperature is still 42 °C after 5 hours of death.
4. The nervous system: unconsciousness, systemic and local convulsions, and intermittent hypotonia and denervation.
5. Respiratory system: severe cyanosis, increased breathing and heart rate.
6. Circulatory system: severe shock, the static pressure of the blood pressure center is extremely low, and the surrounding circulation is poor.
7. Severe bleeding tendency: puncture, bleeding at the injection site, blood in the stool, pulmonary hemorrhage.
8. Progressive reduction of hemoglobin and platelets: Hb can be reduced to below 40g/L.
9. Diffuse intravascular coagulation (DIC): severe coagulopathy, prothrombin time (PT), partial thromboplastin time (PTT) is significantly prolonged, and fibrin degradation products (FDP) are increased.
10. Renal insufficiency: transient renal insufficiency.
11. Liver damage: liver enzyme activities including alanine aminotransferase (GOT), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were significantly increased.
Examine
Examination of hemorrhagic shock and encephalopathy syndrome in children
1. Blood biochemical examination, blood ammonia is normal, blood sugar is mostly normal, a small increase, blood trypsin is increased and 1-antitrypsin is decreased.
2. Blood gas analysis, metabolic acidosis combined with respiratory alkalosis.
3. Cerebrospinal fluid, cerebrospinal fluid is normal, brain cerebral edema can be seen by CT scan.
4. Pathogen examination, bacterial fluid detection of various tissue fluids, blood and organ collections were not positive.
5. Regular X-ray, B-ultrasound, electrocardiogram, brain CT examination.
Diagnosis
Diagnosis and diagnosis of hemorrhagic shock and encephalopathy syndrome in children
diagnosis
Diagnosis is based on clinical performance and laboratory findings.
Differential diagnosis
It must be differentiated from clinically similar diseases such as Reye syndrome, toxic shock, hemolytic uremic syndrome.
