连续血液净化在严重脓毒症患儿中的应用及对炎性因子白细胞介素-6和肿瘤坏死因子-α的调节  

The application of continuous blood purification in children with severe sepsis and regulation on the in- flammatory factor of interleukin-6 and tumor necrosis factor-α

作　　者：许煊[1] 李丹丹[1] 何瑛[1] 高海涛[1] 任海丽[1] 封志纯[1] 

机构地区：[1]北京军区总医院附属八一儿童医院儿章重症监护科,100700

出　　处：《中国小儿急救医学》2013年第1期48-51,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的采用连续血液净化（continuousbloodpurification，CBP）治疗严重脓毒症患儿，观察其临床效果，分析CBP治疗严重脓毒症前后病情危重程度、炎性因子动态变化情况，为临床评价CBP治疗严重脓毒症提供依据。方法收集北京军区总医院附属八一儿童医院重病部2008年8月至2011年5月收治的符合严重脓毒症诊断标准的20例患儿，患儿在行CBP治疗前及CBP治疗后12、24、48h采集平均动脉压、升压药用量、尿量、动脉血气、氧合指数等指标；采用酶联免疫法测定白细胞介素（inter—leukin，IL）-6、肿瘤坏死因子（tumornecrosisfactor，TNF）-α水平；在CBP治疗前及治疗后48h进行危重病例评分。结果20例严重脓毒症患儿经治疗临床好转16例，恶化死亡2例，放弃治疗2例。经CBP治疗后，脓毒症患儿平均动脉压显著上升（P〈0．01），多巴胺和肾上腺素用量显著下降（P〈0．01），尿量显著增多（P〈0．01）；患儿血气指标明显改善，血pH值、碱剩余值基本恢复正常。脓毒症患儿CBP治疗前血中IL-6、TNF-α水平分别为（706．90±275．95）ng／L和（989．67±386．33）ng／L，12h后IL-6、TNF—α水平即开始明显下降，至CBP治疗后48h，患儿血中IL-6、TNF—α水平持续下降至（162．59±63．47）ng／L和（439．08±159．37）ng／L，差异有统计学意义（P〈0．01）。CBP治疗前及治疗后48h，患儿的危重病例评分分别为67．59±25．02和87．05±32．81，差异有统计学意义（P〈0．01）。结论CBP可清除严重脓毒症患儿血液中的炎症介质，改善病情危重程度。Objective To evaluate the clinical effect of continuous blood purification （CBP） in treatment of children with severe sepsis, and analyze the changes of severity of illness and inflammatory factors, which can provide the proof for treatment of children with severe sepsis. Methods Twenty cases with severe sepsis admitted to pediatric intensive care unit of Bayi Children＇s Hosptial Affiliated to General Hospital of Beijing Military Commond from Aug 2008 to May 2011 were treated with CBP. The mean arterial blood pressure, boost dosages, urine output, arterial blood gases, and oxygenation index were collected before CBP and 12,24,48 hours after CBP treatment. The levels of interleukin （IL）-6 and tumor necrosis factor （TNF）-α were determined by enzyme-linked immunosorbent assay. Pediatric critical illness scores were assessed before and 48 h after CBP treatment. Results After the treatment of CBP,16 children were clinical improvement,2 died,2 abandoned the treatment. CBP was effective in the treatment by rising the mean arterial blood pressure （ P 〈 0. 01 ）, decreasing the dosages of dopamine and epinephrine （ P 〈 0. 01 ） , increasing urine output（ P 〈 0. 01 ）. The value of pH and base excess returned to normal basically. The levels of IL-6 and TNF-α were（706. 90 ± 275.95 ） rig/L, （989.67 ± 386. 33） ng/L before the CBP. The levels of IL-6 and TNF-α decreased to （ 162. 59 ± 63.47 ） ng/L, （439.08 ± 159.37 ） ng/L at 48 h after CBP treatment （ P 〈 0. 01 ）. The pediatric critical illness scores were 67.59 ± 25.02 and 87.05 ± 32. 81 before CBP and at 48 h after CBP, which showed significant difference（ P 〈 0. 01 ）. Conclusion The treatment of CBP can remove in- flammatory factors in children with severe sepsis and improve the severity of illness.

关 键 词：连续血液净化 严重脓毒症 儿童 

分 类 号：R7[医药卫生—临床医学]