连续性高容量血液滤过对严重脓毒症患儿的疗效分析  

The efficacy of continuous high volume hemofiltration in children with severe sepsis

作　　者：陈振杰[1] 叶盛[1] 张晨美[1] 

机构地区：[1]浙江大学医学院附属儿童医院PICU,杭州 310052

出　　处：《中国医学前沿杂志（电子版）》2017年第10期75-78,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：浙江省卫计委课题一般资助项目(2014KYA120)

摘　　要：目的分析连续性高容量血液滤过(continuous high volume hemofiltration,CHVHF)对严重脓毒症患儿的疗效。方法选择2014年6月至2016年8月本院收治的严重脓毒症患儿47例为研究对象,根据患儿是否接受CHVHF治疗,将其分为研究组(24例)和对照组(23例)。对照组患儿采取综合治疗,研究组患儿在对照组基础上行床旁CHVHF治疗,连续观察72小时。比较治疗前和治疗24小时、48小时及72小时后两组患儿的氧合指数、血乳酸、血肌酐、血尿素氮、白介素(interleukin,IL)-6、IL-10、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平及治疗后并发症发生情况。结果治疗后两组患儿氧合指数、血乳酸、血肌酐、血尿素氮、IL-6、IL-10、TNF-α水平与治疗前比较均有显著差异(P<0.05)。治疗48小时和72小时后,研究组患儿氧合指数均显著高于对照组(P<0.05),血乳酸水平均显著低于对照组(P<0.05)。治疗24小时后,研究组患儿血肌酐水平显著低于对照组(P<0.05)。治疗72小时后,研究组患儿IL-6水平显著低于对照组(P<0.05)。治疗48小时和72小时后,研究组患儿IL-10水平均显著低于对照组(P<0.05)。治疗24、48、72小时后,研究组患儿TNF-α水平均显著低于对照组(P<0.05)。研究组患儿并发症发生率显著低于对照组(χ~2=7.6855,P=0.0056)。结论 CHVHF对严重脓毒症患儿的疗效较好,安全性较佳。Objective To evaluate the efficacy and prognosis of continuous high volume hemofiltration（CHVHF） in the treatment of children with severe sepsis. Method 47 children with severe sepsis admitted to our hospital from June 2014 to August 2016 were enrolled in this study, they were divided into study group（24 cases） and control group（23 cases） according to whether received CHVHF treatment or not. Control group children were treated with comprehensive treatment, study group children were treated with CHVHF treatment on the basis of control group, continuously observed of 72 hours. The oxygenation index, the levels of blood lactic acid, serum creatinine, blood urea nitrogen, interleukin（IL）-6, IL-10 and tumor necrosis factor-α（TNF-α） and the incidence of postoperative complications were compared before treatment and 24 hours, 48 hours and 72 hours after treatment between the two groups. Result After treatment, there were significant differences in oxygenation index, blood lactic acid, serum creatinine, blood urea nitrogen, IL-6, IL-10 and TNF-α between the two groups（P〈0.05）. 48 hours and 72 hours after treatment, the oxygenation index of study group were significantly higher than those of control group（P〈0.05）, the level of blood lactic acid was significantly lower than that of control group（P〈0.05）. 24 hours after treatment, the level of serum creatinine was significantly lower than that of control group（P〈0.05）. 72 hours after treatment, the level of IL-6 was significantly lower than that of control group（P〈0.05）. 48 hours and 72 hours after treatment, the level of IL-10 were significantly lower than those of control group（P〈0.05）. 24 hours, 48 hours and 72 hours after treatment, the levels of TNF-α were significantly lower than those of control group（P〈0.05）. The complications incidence of study group was significantly lower than that of control group（χ~2= 7.6855, P =0.0056）. Conclusion CHVHF has better efficacy and better safety in children with

关 键 词：小儿 严重脓毒症 连续性高容量血液滤过 

分 类 号：R720.597[医药卫生—急诊医学]