连续性血液净化联合血液灌流治疗危重症合并急性肾衰竭  

Continuous Blood Purification Combined with Hemoperfusion for Treating Critically Sick Children with Acute Renal Failure

作　　者：徐媛[1,2] 董扬[1,2] 徐达良[2] 高敏[2] 李梅[2] 吴成[2] 金丹群[2] 李林[3] 赵燕[2] 江家云[2] 朱颖[2] 

机构地区：[1]安徽医科大学儿科临床学院,合肥230032 [2]安徽省立儿童医院肾内科,合肥230051 [3]安徽省立儿童医院检验科,合肥230051

出　　处：《实用儿科临床杂志》2011年第6期401-403,共3页Journal of Applied Clinical Pediatrics

基　　金：安徽省卫生厅临床医学技术应用项目(2008B075)

摘　　要：目的探讨连续性血液净化（CBP）联合血液灌流（HP）治疗儿童危重症合并急性肾衰竭（ARF）的疗效及安全性。方法 2009年4月-2010年8月在本院行CBP联合HP治疗的儿童危重症合并ARF患儿10例。选择连续性静脉-静脉血液透析滤过（CVVHDF）模式进行床旁CBP治疗,治疗时间持续8~36 h,同时序贯加用珠海丽珠医用生物材料有限公司HA系列树脂灌流器进行HP治疗,治疗时间2 h。观察治疗前后血BUN、血肌酐（SCr）、ALT、CK、电解质、CRP、内皮素（ET）、中心静脉压（CVP）、平均动脉压（MAP）、氧合指数[pa（O2）/FiO2]和血气分析等指标变化,采用SPSS 13.0软件进行统计学处理。结果 CBP联合HP治疗后血BUN、SCr、TB、ALT、CK明显降低;电解质、酸碱平衡紊乱得到纠正,CRP显著降低,pa（O2）/FiO2显著提高;治疗过程中血流动力学稳定,ET、HR及CVP较治疗前明显降低,差异均有统计学意义（Pa〈0.05）。治愈6例,好转、放弃治疗各2例。结论 CBP联合HP治疗过程中,血流动力学稳定,有效纠正氮质血症和水电解质、酸碱平衡紊乱,是治疗儿童危重症合并ARF的一种安全、有效的方法。Objective To investigate the efficacy and safety of continuous blood purification（CBP） combined with hemoperfusion（HP） for treating critically sick children with acute renal failure（ARF）.MethodsTen critically sick children with ARF treated with CBP combined with HP were studied.These children with ARF were hospitalized in Anhui Provincial Children′s Hospital from Apr.2009 to Aug.2010.Continuous veno-venous hemodiafiltration（CVVHDF） model was selected and treated at the bedside with CBP therapy lasting 8 to 36 hours.HP was sequentially performed with HA series resin manufactured by Zhuhai Franc Biomedical Materials Co.Ltd.,perfusion lasting for 2 hours.The changes in indexes were observed,including blood urea nitrogen（BUN）,serum creatinine（SCr）,alanine aminotransferase（ALT）,creatine phosphokinase（CK）,electrolytes,C reactive protein（CRP）,endothelin（ET）,central venous pressure（CVP）,mean arterial pressure（MAP）,oxygenation index[pa（O2）/FiO2],arterial blood gas analysis and so on before and after treatment.The statistical analysis of the results were performed by SPSS 13.0 software.ResultsThe levels of blood BUN,SCr,body temperature,ALT,CK were significantly reduced after CBP combined with HP treatment;electrolyte,acid-base balance disorders were corrected.CRP was decreased dramatically,pa（O2）/FiO2 significantly increased;the hemodynamics of patients were stable during the treatment and ET,heart rate,and CVP were significantly lower than before therapy.The above differences were statistically significant（Pa0.05）.Six cases got cured,2 cases gave up,2 cases got better.ConclusionsThe hemodynamics in children are stable,and nitremia,water electrolyte,and acid-base equilibrium disorder are effectively corrected in the course of treatment by CBP combined with HP,which is a safe and effective way in treating critically ill children with ARF.J Appl Clin Pediatr,2011,26（6）： 401-403

关 键 词：连续性血液净化 血液灌流 肾衰竭 急性 儿童 

分 类 号：R726.9[医药卫生—儿科]