Abstract: Refractory septic shock （RSS） is the most common cause of early death in children with septic shock.The mortality of RSS remains high.How to successfully diagnose and treat RSS has become the focus and difficulty of pediatric intensive care unit （PICU）， and it is also an important means to reduce the mortality of SS. RSS often presents with refractory shock and persistent hyperlactacemia. Catecholamines are the first-line drugs to improve hypotension and hypoperfusion. However， with the increase of drug dosage， related complications also increase significantly， and new strategies need to be further sought. At present， there is no clear and unified saving strategy for children's RSS. The article review the updating of RSS  guidelines， suggestions on hemodynamic evaluation methods， progress of therapeutic drugs and treatment methods， aiming to provide help for clinical optimization of RSS treatment.

Key words: sepsis, refractory septic shock, treatment, child

摘要： 难治性脓毒性休克（refractory septic shock，RSS）是脓毒性休克患者早期死亡的最常见原因，其病死率仍居高不下，如何有效救治RSS患者是重症监护室治疗的重点和难点。RSS表现为顽固性休克、持续高乳酸血症，儿茶酚胺类药物是改善RSS低血压、低灌注的一线药物，但随着药物剂量加大，并发症也显著增加，因此需进一步寻找新的治疗策略。目前尚无明确、统一的儿童RSS挽救性策略。文章从RSS治疗指南建议更新、血流动力学评估、药物治疗进展及治疗手段等方面进行综述，旨在为临床优化RSS治疗提供参考。

关键词: 脓毒症, 难治性脓毒性休克, 治疗, 儿童