危重患儿持续性静脉-静脉血液滤过治疗剂量的探讨  

Effects of different doses of continuous veno-venous hemofiltration on outcome of critically ill children

作　　者：董伟[1] 梁华般[1] 宋利[1] 刘双信[1] 李锐钊[1] 陈源汉[1] 莫立仪 李志莲[1] 史伟[1] 梁馨苓[1] DONG Wei LIANG Hua-ban SONG Li LIU Shuang-xin LI Rui-zhao CHEN Yuan-han MO Li-yi Li Zhi- lian SHI Wei LIANG Xin-ling(Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China)

机构地区：[1]广东省人民医院(广东省医学科学院),广州510080

出　　处：《中国血液净化》2017年第1期35-38,共4页Chinese Journal of Blood Purification

基　　金：国家临床重点专科建设项目"十二五"国家科技支撑计划项目(2011BAI10B08);广东省自然科学基金(2014A03031345)

摘　　要：目的观察持续静脉-静脉血液滤过(continuous venous-venous hemofiltration,CVVH)治疗剂量对危重患儿预后的影响。方法回顾性纳入2010年1月~2015年12月期间广东省人民医院接受CVVH治疗的危重患儿。比较CVVH处方低剂量组[≤35ml/(kg·h)]及高剂量组[>35ml/(kg·h)]间的预后。结果高剂量组和低剂量组30天住院死亡率(38.5%比46.2%,χ~2=0.265,P=0.607)、总住院时间[15(13,21)比17(9,24),Z=-0.239,P=0.811]及ICU内住院时间[13(6,21)比12(6,17),Z=-0.448,P=0.654]均无统计学差异。在Cox回归中对其他危险因素校正后,高剂量组仍未能减少住院死亡(HR0.768,95%CI,0.261~2.264,P=0.632)。结论超过35ml/(kg·h)的CVVH处方剂量未能改善危重患儿预后。Objective The aim of this study is to evaluate the effect of different doses of continuous venovenous hemofiltration （CVVH） on outcome of critically ill children. Methods The clinical data of critically ill children treated with CVVH in the Pediatric Intensive Care Unit of Guangdong General Hospital between Jan. 2010 and Dec. 2015 were retrospectively analyzed. They were divided into two groups based on the precribed effluent volume： lower dose group （prescribed effluent volume ≤35 ml/kg/h） and higher dose group （prescribed effluent volume 〉35ml/kg/h）. The in-hospital outcomes including 30 days in-hospital mortality, lengths of stay in hospital and in ICU were compared between the two groups. Results A total of 39 critically ill children were enrolled in this study. The 28 days in-hospital mortality was 43.6%, and the median lengths of stay in hospital and in ICU were 16 （10,24） and 19 （12,30） days respectively. There were no significant differences in 30 days in-hospital mortality （38.5% vs. 46.2%, 0.265, P=-0.607）, lengths of stay in hospital [15 （13,21） vs. 17 （9,24）, Z=-0.239, P=-0.811] and in ICU [13 （6,21） vs. 12 （6,17）, Z=-0.448, P= 0.654] between the two groups. Multivariate Cox＇ s proportional hazards regression found that the higher dose group was not associated with the lower risk of in-hospital death （HR=0.768; 95% CI 0.261-2.264, P=0.632）. Conclusions Effluent volume 〉35ml/kg/h was not related to the better outcome in hospital. Therefore, the CVVH dose for critically ill children can follow the guideline for adults that recommends the practical effluent volume of 20-25 ml/（kg · h） or prescribed effluent volume of 30-35ml/（kg· h）.

关 键 词：死亡率 剂量 肾脏替代治疗 持续性静脉-静脉血液滤过 危重患儿 

分 类 号：R459.5[医药卫生—治疗学]