KHẢO SÁT THAY ĐỔI HUYẾT ĐỘNG, ĐIỆN GIẢI, KIỀM TOAN VÀ RỐI LOẠN ĐÔNG MÁU Ở BỆNH NHÂN SỐC SỐT XUẤT HUYẾT DENGUE ĐƯỢC ĐIỀU TRỊ DUNG DỊCH HYDROXYETHYL STARCH 130 6%

Abstract

Objectives: To explore hemodynamic, electrolytes, acid-base changes and coagulation disorders in Dengue shock syndrome (DDS) treated with HydroxyEthyl Starch 130 6% solution  admitted at City children’s hospital from June 2020 till June 2021.

Method: Retrospective case series study

Results: 60 DDS children treated with HydroxyEthyl Starch 130 6% solution were investigated. The mean age was 5.4 years old, ranging from 14 months old to 14 years old. Assessment of hemodynamic changes within 24 hours after HES 130 6% infusion showed that shock condition improved with reduced mean heart rate at 4^th hours (121.3 vs.101.6),  widened pulse pressure at first hour while systolic, diastolic, mean blood pressures stabilized at level of  92.5 – 108.4 mmHg, 73.2-66.2 mmHg, 78.6-82.7 mmHg. Mean hematocrit at one hour after HES 130 6% infusion was 38.6%, significantly improved from 43.4% at baseline and stabilized at 37.5-38.4% thereafter. There were no significant abnormal changes in electrolytes, acid-base, or coagulation. The average amount of HES 130 6% solution used was 133.8 ± 15.3 ml/kg over a mean duration of 25.3 ± 2.6 hours. Complications caused possibly by infusion of HES 130 6% solution including respiratory failure (56.7%) due to pleural and peritoneal effusion; gastrointestinal bleeding (8.3%). No infusion tremor or anaphylaxis was observed during infusion of HES 130 6% solution. The failure rate with HES 130 6% solution, switching to HES 200 6% or dextran 40 10% was 38.3%. No death was documented.

Conclusions: The study helps clinicians have an additional option of HES 130 6% solution in the treatment of dengue shock syndrome when the source of high-molecular solution is scarce such as HES 200 6%, dextran 40 10%. However, the application of HES 130 6% solution is only for DSS, not for severe DSS and acute respiratory failure occurring during infusion needs to be noted and supported timely.