连续血液净化治疗婴儿严重脓毒症的临床分析  

Clinical analysis of continuous blood purification in the treatment of severe sepsis in infants

作　　者：臧平 党西强[1] 卢秀兰[2] 肖政辉[2] 黄娇甜[2] 朱德胜[2] Zang Ping;Dang Xiqiang;Lu Xiulan;Xiao Zhenghui;Huang Jiaotian;Zhu Desheng(Pediatric Nephrology Department,Children＇s Medical Center,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院儿童医学中心儿童肾脏专科,长沙410011 [2]湖南省儿童医院急救中心,长沙410007

出　　处：《中国小儿急救医学》2018年第9期655-660,共6页Chinese Pediatric Emergency Medicine

基　　金：国家“十二五”科技支撑计划（2012BAI04B02）

摘　　要：目的探讨连续血液净化（CBP）治疗婴儿严重脓毒症的临床疗效及安全性。方法回顾性分析2014年1月至2017年7月湖南省儿童医院PICU收治的行CBP治疗的婴儿严重脓毒症40例（CBP组），同期未行CBP治疗的婴儿严重脓毒症50例为对照（对照组）。所有患儿在CBP治疗前、治疗后第3天均进行血气分析、乳酸、血糖、电解质、血常规、C-反应蛋白、降钙素原、谷丙转氨酶、谷草转氨酶、总胆红素、尿素氮、血肌酐、MB型肌酸激酶同工酶等指标的监测，并评估小儿危重病例评分（PCIS）。结果（1）治疗后CBP组的体温、心率、呼吸频率、血压的恢复情况优于对照组，差异均有统计学意义（P均〈0．05）。（2）治疗后两组患儿的实验室指标：碱剩余、乳酸、白细胞、降钙素原、C-反应蛋白、谷丙转氨酶、谷草转氨酶、总胆红素、尿素氮比较，CBP组恢复情况均优于对照组，差异均有统计学意义（P均〈0．05）。（3）CBP组APCIS（D3-D1）高于对照组，差异有统计学意义（P〈0．05）。（4）CBP组病死率低于对照组，但差异无统计学意义（P〉0．05）。（5）CBP组患儿发生血小板减少2例，股静脉血栓2例，低血容量性休克2例，滤器内凝血1例，所有患儿均未发生穿刺部位感染。结论CBP可改善严重脓毒症婴儿的生命体征、内环境、炎症反应和脏器功能，其效果优于传统方法；CBP应用于婴儿严重脓毒症时的并发症相对较多，应严格掌握其治疗儿童严重脓毒症的指征。Objective To investigate the clinical efficacy and safety of continuous blood purification （CBP） in the treatment of severe sepsis in infants. Methods A retrospective analysis of 40 infants with severe sepsis treated with CBP was performed at PICU of Hunan Children＇s Hospital from January 2014 to July 2017, and 50 infants with severe sepsis who were not treated with CBP at the same period were enrolled as control group. The indicators included blood gas analysis, lactic acid （ Lac ）, blood glucose, electrolytes, blood routine, C-reaction protein （ CRP ） and procalcitonin （ PCT ）, alanine aminotransferase （ ALT ） and aspartate aminotransferase （AST） ,total bilirubin（ TB ）, urea nitrogen （ BUN）, serum creatinine （Scr） and creatine kinase isoenzyme MB （ CK-MB ）, pediatric critical illness score （ PCIS ）. Results （ 1 ） After 3 days of treatment, the recovery of body temperature, heart rate, respiratory rate and blood pressure in CBP group were better than those in the control group, and the differences between two groups were statistically signifi- cant （ P 〈 0. 05 ）. （2） After treatment, the levels of base excess （ BE ）, Lac, white blood cell （ WBC ）, PCT, CRP, ALT, AST, TB and BUN of CBP group recovered better than those of the control group, the differences were statistically significant （ P 〈 0.05 ）. （ 3 ） The APCIS （ D3-D1 ） of CBP group was higher than that of the control group, and the difference between two groups was statistically significant （ P 〈 0. 05 ）. （ 4 ） The fatali- ty rate of CBP group was lower than that of the control group, and there was no significant difference between two groups （P 〉 0. 05 ）. （5） Two cases of thrombocytopenia ,2 cases of femoral vein thrombosis ,2 cases of hypovolemic shock, and 1 case of blood coagulation in filter happened in CBP gruop, all cases had no punc- ture site infection. Conclusion CBP can improve the vital signs,internal environment,inflammatory reaction and organ

关 键 词：连续血液净化 严重脓毒症 婴儿 临床疗效 安全性 

分 类 号：R720.597[医药卫生—急诊医学]