血液滤过辅助抢救儿童危重型肠道病毒71型感染  

Blood purification on severe enterovirus 71-associated hand, foot and mouth disease in children

作　　者：朱艳[1] 崔云[1] 王斐[1] 缪惠洁[1] 王春霞[1] 张育才[1] Zhu Yan;Cui Yun;Wang Fei;Miao Huijie;Wang Chunxia;Zhang Yucai.(Department of Critical Care Medi- cine, Shanghai Children＇s Hospital, Shanghai Jiaotong University, Shanghai 200040, Chin)

机构地区：[1]上海市儿童医院上海交通大学附属儿童医院重症医学科,200040

出　　处：《中国小儿急救医学》2018年第4期278-281,共4页Chinese Pediatric Emergency Medicine

基　　金：上海申康医院发展中心新兴前沿技术项目（SHDC12014116）;上海交通大学医学院临床多中心研究项目（DLY201618）

摘　　要：目的探讨床旁连续性血液净化（continuous blood purification，CBP）治疗在抢救儿童重症肠道病毒71型（enterovirus 71，EV71）感染中的作用。方法回顾性总结上海市儿童医院PICU 2012年1月至2016年12月收治的76例诊断重症EV71感染患儿的临床资料，根据《肠道病毒71型（EV71）感染重症病例临床救治专家共识》（2011年）进行临床分期治疗。对临床分期3期、4期的重症EV71感染患儿，在常规治疗基础上加用CBP协助抢救治疗，观察患儿的心血管功能变化、血液活性物质水平与转归情况。结果76例重症EV71感染3期和4期患儿21例，其中17例患儿进行CBP治疗，采用连续性静-静脉血液透析滤过（continuous venovenous hemodiafiltration，CVVHDF）模式。17例患儿的平均CVVHDF时间（中位数）为48（36，64）h，存活14例，存活率为82.4%。CVVHDF治疗后，血液血管紧张素Ⅱ[185.9（125.2，800.0） ng/L比106.0（90.8，232.5） ng/L]、醛固酮[165.7（94.0，353.3） ng/L比103.3（84.3，144.3）ng/L]、血浆肾素[1.12（0.74，3.45） μg/（L·h）比0.79（0.52，1.25） μg/（L·h） ]、肾上腺素[169.8（145.5，244.6） ng/L比148.0（109.0，208.1） ng/L]、多巴胺[152.7（97.0，191.1） ng/L比96.0（68.0，160.9） ng/L]、血乳酸[3.50（2.75，3.90） mmol/L比1.30（0.95，1.90） mmol/L]，较治疗前均有下降（P均〈0.05）；治疗前后患儿的体温、心率、收缩压、左室射血分数和心脏指数较治疗前明显改善（P均〈0.05）。ObjectiveTo assess the clinical benefits of continuous blood purification（CBP） in severe enterovirus 71（EV71）-associated hand, foot and mouth disease （HFMD） in children.MethodsWe retrospectively analyzed the medical records of pediatric patients with EV71-associated HFMD admitted to PICU in Shanghai Children′s Hospital from January 2012 to December 2016.Severity of EV71-associated HFMD was graded in the accordance with the expert consensus on severe EV71-infected HFMD.According to the severity, the patients with stage 2 HFMD were treated with standard management, and the patients with stage 3-4 HFMD were treated with continuous veno-venous hemodiafiltration（CVVHDF） as an adjuvant therapy.Patient demographics, clinical characteristics, cardiovascular function indexes, outcome and complications of CVVHDF were collected and analyzed.ResultsA total of 76 patients with severe EV71-associated HFMD were enrolled in this study.Among them, there were 21 patients with stage 3-4 HFMD, and 17 cases were treated with CVVHDF as an adjuvant therapy with a survival rate of 82.4 %（14/17）. The median time of CVVHDF treatment was 48（36, 64）h.The plasma levels of angiotensin Ⅱ[185.9（125.2, 800.0） ng/L vs. 106.0（90.8, 232.5） ng/L], aldosterone[165.7（94.0, 353.3） ng/L vs. 103.3（84.3, 144.3）ng/L], rennin[1.12（0.74, 3.45） μg/（L·h） vs. 0.79（0.52, 1.25） μg/（L·h） ], adrenaline[169.8（145.5, 244.6） ng/L vs. 148.0（109.0, 208.1） ng/L], dopamine[152.7（97.0, 191.1） ng/L vs. 96.0（68.0, 160.9） ng/L], and lactate[3.50（2.75, 3.90） mmol/L vs. 1.30（0.95, 1.90） mmol/L] were significantly decreased after CVVHDF treatment（all P〈0.05, respectively）. The fever, heart rate, systolic blood pressure, left ventricular ejection fraction and cardiac index of the patients were significantly improved after treatment（all P〈0.05, respectively）.Conclusion CBP is an important rescue therapy for patients with severe EV71-infected HFMD, which results in rapidly improving

关 键 词：连续性静一静脉血液透析滤过 肠道病毒71型 手足口病 危重症 儿童重症监护病房 

分 类 号：R725.1[医药卫生—儿科]