不同剂量置换液连续性血液净化治疗小儿呼吸窘迫综合征的临床疗效比较  

Comparison of Different Doses in Continuous Blood Purification Treatment on Children with Acute Respiratory Distress Syndrome

作　　者：熊道学[1] 姜建渝[1] 冯琰[1] 王玲[1] 成艳[1] XIONG Dao - xue JIANG Jian - yu FENG Yan WANG Ling CHENG Yan.(Pediatric Intensive Care Unit, Chongqing Three Gorges Central Hospital, Chongqing 404000, Chin)

机构地区：[1]重庆三峡中心医院儿童重症医学科,重庆市404000

出　　处：《中国全科医学》2016年第30期3675-3680,共6页Chinese General Practice

摘　　要：目的比较常规剂量置换液与高剂量置换液连续性血液净化(CBP)治疗小儿呼吸窘迫综合征(ARDS)的临床疗效。方法选取2012—2015年重庆三峡中心医院儿童重症医学科(PICU)收治的符合纳入标准的ARDS患儿31例,按照随机数字表法分为常规剂量组15例及高剂量组16例。两组患儿均在常规机械通气等疗法基础上,采用连续性静-静脉血液透析滤过(CVVHDF)模式进行CBP治疗,常规剂量组给予常规剂量置换液(20~35 ml·kg^(-1)·h^(-1))治疗,高剂量组给予高剂量置换液(50~70 ml·kg^(-1)·h^(-1))治疗。以患儿死亡或转出PICU作为研究终点,观察两组患儿的治疗结果;比较两组患儿治疗前(治疗0 h)及治疗中(24、48、96、144 h)氧合指数(Pa O_2/Fi O_2)、p H值、动脉血氧分压(Pa O_2)、动脉血二氧化碳分压(Pa CO_2)、碱剩余(BE)、吸入氧浓度(Fi O_2)、呼吸频率、吸气峰压(PIP)、呼气末正压(PEEP)、潮气量(Vt),治疗120 h时小儿危重病例评分(PCIS)、第三代小儿死亡风险(PRISMⅢ)评分,CBP治疗时间、机械通气时间、入住PICU时间以及CBP治疗期间不良事件(包括寒战/低体温、低血压、高血压、滤器凝血、局部和/或全身出血)发生情况。结果两组患儿治疗好转率比较,差异无统计学意义(P=0.121)。剂量与时间在Pa O_2/Fi O_2、p H值、Pa O_2、Pa CO_2、BE、Fi O_2、呼吸频率、PIP、PEEP、Vt上不存在交互作用(P>0.05);剂量对Pa O_2/Fi O_2、Pa O2的主效应显著(P<0.05);剂量对p H值、Pa CO_2、BE、Fi O_2、呼吸频率、PIP、PEEP、Vt的主效应不显著(P>0.05);时间对Pa O_2/Fi O_2、p H值、Pa O_2、Pa CO_2、BE、Fi O_2、呼吸频率、PIP、PEEP、Vt的主效应显著(P<0.05)。高剂量组患儿治疗24 h时Pa O_2/Fi O_2、Pa O_2高于常规剂量组,PEEP低于常规剂量组(P<0.05);高剂量组患儿治疗48 h时Pa O_2/Fi O_2、Pa O_2高于常规剂量组,Pa CO_2、Fi O_2、PIP低于常规剂量组(P<0.05)。高剂量组患儿治疗120 h时PCIS高�Objective To compare the efficacy of routine- dose and high- dose continuous blood purification（ CBP）on the treatment of acute respiratory distress syndrome（ ARDS） in children. Methods 31 patients were enrolled who met the criteria for ARDS and were treated at the Pediatric Intensive Care Unit（ PICU） of Chongqing Three Gorges Central Hospital from2012 to 2015. All the patients were assigned to the routine- dose treatment（ n = 15） and the high- dose treatment（ n = 16） by a random number table. The two groups were treated with CBP using the continuous veno- venous hemodiafiltration（ CVVHDF）mode on the basis of mechanical ventilation. The routine- dose group received routine replacement liquid dose（ 20- 35 ml·kg^-1·h^-1） treatment,and the high- dose group received high replacement liquid dose（ 50- 70 ml·kg^-1·h^-1） treatment. End points included the death of patients and the discharge from PICU. Observed the treatment outcomes of the two groups. The oxygenation index（ PaO_2/ FiO_2）,p H values,arterial blood oxygen tension（ PaO_2）,partial pressure of carbon dioxide（ PaCO_2）,base excess（ BE）,inspiratory oxygen concentration（ FiO_2）,respiratory rate,peak airway pressure（ PIP）,positive end- expiratory pressure（ PEEP） and tidal volume（ Vt） were compared between the two groups before（ 0 h） and during（ 24,48,96,144 h） treatment. And pediatric critical illness score（ PCIS） and the pediatric risk of mortality（ PRISMⅢ） scores after OBP for treating 120 hours,the duration of CBP therapy,mechanical ventilation time,the length of stay in PICU and the adverse events（ including chills / hypothermic, hypotension, hypertension, filters clotting and local and / or systemic hemorrhage） during CBP treatment were also compared between the two groups. Results There was no significant difference in the improvement between the two groups（ P = 0. 121）. There was no interaction effect between dose and time on PaO_2/ FiO_2,p H,PaO_2,PaCO_2,BE,FiO_2,r

关 键 词：呼吸窘迫综合征 血液透析滤过 剂量效应关系 疗效比较研究 

分 类 号：R722.12[医药卫生—儿科]