连续性血液净化在儿科ICU患者中的应用价值:附203例病例分析  

Application value of continuous blood purification in pediatric intensive care unit:analysis of 203 cases

作　　者：赵劭懂[1] 葛许华[1] 徐鹏宏 刘勇 时珺[1] 缪红军[1] Zhao Shaodong;Ge Xuhua;Xu Penghong;Liu Yong;Shi Jun;Miao Hongjun(Centre of PICU,Children's Hospital of Nanjing Medical University,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京医科大学附属儿童医院重症医学科,江苏南京210008

出　　处：《中华危重病急救医学》2018年第12期1150-1153,共4页Chinese Critical Care Medicine

基　　金：江苏省南京市医学科技发展项目(YKK16181).

摘　　要：目的探讨连续性血液净化(CBP)技术在儿科重症加强治疗病房(ICU)中的临床应用价值。方法采用回顾性研究方法,选择2015至2017年南京医科大学附属儿童医院PICU收治的进行CBP治疗病例,对其疾病谱、CBP治疗模式、置管部位、抗凝方式、治疗时间及不良反应等进行总结分析。结果①共纳入203例患儿,男性占59.1%;年龄37d^14岁,平均(4.52±3.60)岁;体重3.3~68.0kg,平均(21.38±13.77)kg。②203例患儿共进行660次CBP治疗,平均每例3.25次。CBP治疗模式以血浆置换(PE,占38.64%)和连续性静-静血液透析滤过(CVVHDF,占38.64%)为主,其次为血液灌流(HP,占16.51%)、连续性静-静血液滤过(CVVH,占6.21%)。③中心静脉置管部位主要以选择右侧颈内静脉为主(占90.64%),其次为右侧股静脉(占5.42%)、左侧股静脉(占3.94%)。④管路滤器以肝素钠抗凝为主(占84.73%),其次为低分子肝素钙(占11.33%),枸橼酸钠与无抗凝均占1.97%;21例为混合抗凝。⑤原发病包括中毒(占26.11%)、肝功能衰竭(占25.62%)、脓毒症(占12.32%)、休克心肺复苏术后(11.82%)、急性呼吸窘迫综合征(ARDS,占8.37%)、中枢神经系统疾病(占5.42%)、代谢病(占4.93%)。CBP疗效最差的是代谢病,病死率为60.00%;其次为ARDS、休克心肺复苏术后、脓毒症、肝功能衰竭,病死率分别为58.82%、41.67%、36.00%、32.69%。中枢神经系统疾病患儿住院时间较长,为(30.89±15.13)d。⑥CBP治疗的不良事件包括难以控制的烦躁不安(2.88%)、低血压(1.82%)、过敏性皮疹(1.21%)、置管及管路凝血(1.21%)、滤器凝血(1.06%)及心率和血氧饱和度下降(0.76%);有8例患儿在治疗过程中因心跳停止而终止血液净化。结论目前,CBP在儿科ICU中的应用已比较成熟,是抢救危重症患儿的重要手段。Objective To explore the clinical application value of the continuous blood purification(CBP)technology in pediatric intensive care unit(ICU).Methods A retrospective study was conducted.All CBP patients admitted to pediatric ICU of Children's Hospital of Nanjing Medical University from 2015 to 2017 were enrolled.The disease diagnosis,CBP treatment mode,catheter placement,anticoagulation way,treatment time and adverse reactions were summarized and analyzed.Results ① A total of 203 children were included,male accounted for 59.1%;age 37 days to 14 years old,with an average of(4.52±3.60)years old;weight 3.3-68.0 kg,with an average of(21.38±13.77)kg.② There were a total of 660 CBP treatments,with an average of 3.25 times per person.The main treatment modes of CBP were plasma exchange(PE,38.64%),and followed by continuous veno-venous hemodiafiltration(CVVHDF,38.64%),hemoperfusion(HP,16.51%)and continuous veno-venous hemofiltration(CVVH,6.21%).③ Central venous catheterization was mainly placed in the right internal jugular vein(90.64%),followed by the right femoral vein(5.42%)and the left femoral vein(3.94%).④ Heparin sodium was the main anticoagulant in pipeline filters(84.73%),followed by low molecular weight heparin calcium(11.33%),sodium citrate and non-anticoagulant(both 1.97%).Mixed anticoagulants were used 21 children.⑤ Primary diseases included poisoning(26.11%),liver failure(25.62%),sepsis(12.32%),shock after cardiopulmonary resuscitation(11.82%),acute respiratory distress syndrome(ARDS,8.37%),central nervous system diseases(5.41%)and metabolic diseases(4.93%).The lowest efficacy of CBP was metabolic diseases,with mortality rate of 60.00%;followed by ARDS,shock after cardiopulmonary resuscitation,sepsis and liver failure,with mortality was 58.82%,41.67%,36.00% and 32.69%,respectively.The length of hospitalization stay of children with central nervous system diseases was(30.89±15.13)days.⑥ Adverse events of CBP treatment included uncontrollable restlessness(2.88%),hypotension(1.82%),allergic rash(

关 键 词：血液滤过 重症加强治疗病房 儿科 

分 类 号：R726.9[医药卫生—儿科]