Objective To investigate the effects of balanced salt solution and normal saline resuscitation strategies on the intestinal flora and prognosis of children with sepsis.

Methods A total of 47 children with sepsis from the PICU to February 2022 were randomly divided into the group A (22 cases) and group B(25 cases).The group A were treated with standard treatment combined with 0.9% sodium chloride fluid resuscitation, while the group B were treated with standard treatment combined with lactated Ringer's solution resuscitation.The oxygenation index, serum creatinine, urea, lactate, inflammatory cytokines(IL-6, IL-10 and TNF-α), child mortality risk Ⅲ(PRISM Ⅲ) score and 28-day mortality were compared betwteen two groups.The composition of gut microbiota was analyzed by 16S rDNA sequencing.

Results There was no statistcial significance in the 28-day mortality between two groups(P>0.05).Compared with 0 h, the IL-6 and PRISMⅢ in group A decreased after 72 h of fluid resuscitation(P < 0.05 and P < 0.01), and there was no statistical significance in other indexes(P>0.05).The 8 indexes in the group B were improved to varying degrees (P < 0.05 to P < 0.01), and the improvement degree of which in the group B was higher than that in group A(P < 0.05 to P < 0.01).After 72 h of treatment, the serum creatinine, blood urea, IL-6, IL-10 and TNF-α concentrations in the group B were lower than those in group A(P < 0.05).The results of principal coordinate analysis revealed significantly different clusters of two groups.According to the LDA score, the species in the group A were Clostridium, Clostridium, Firmicutes, Ruminococcaceae and Faecalis, and the species in the group B were Bacteroidetes, Bacteroidetes and Firmicutes, respectively.

Conclusions Balanced salt is an effective fluid resuscitation strategy in children with sepsis, which may play a role by altering the bacterial ecology in the children's gastrointestinal tract.