连续性血液净化治疗新生儿重症脓毒症伴多器官功能障碍综合征临床效果分析  

Clinical effects of continuous blood purification in the treatment of newborns with severe sepsis and multiple organ dysfunction syndrome

作　　者：李晓庆[1] 陈冬梅[1] 王瑞泉[1] 吴联强[1] 张伟峰[1] 许景林[1] 陈志旭[1] Li Xiaoqing;Chen Dongmei;Wang Ruiquan;Wu Lianqiang;Zhang Weifeng;Xu Jinglin;Chen Zhixu(Department of Neonatology,Quanzhou Children's Hospital,Quanzhou 362000,China)

机构地区：[1]泉州市儿童医院新生儿科,362000

出　　处：《中华新生儿科杂志（中英文）》2019年第5期334-337,共4页Chinese Journal of Neonatology

摘　　要：目的探讨连续性血液净化(continuous blood purification,CBP)治疗新生儿重症脓毒症伴多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)的临床效果.方法选取2013年5月至2018年11月在泉州市儿童医院新生儿科行CBP治疗的重症脓毒症伴MODS患儿临床资料,回顾性分析患儿CBP治疗前后及不同时间点的血压、动脉血氧分压/吸入氧浓度、pH、血钾、血钠、尿素氮、肌酐、尿量及肾上腺素维持剂量的变化情况.应用SPSS统计软件进行数据分析.结果共纳入8例进行CBP治疗的脓毒症伴MODS新生儿,1例合并结肠穿孔,1例合并急性肾衰竭;受累脏器3~5个;6例患儿于入院后1~5 d内即开始CBP治疗,另2例分别在入院第38、47天开始CBP治疗;转流时间(58.6±25.9)h;6例治疗有效.与治疗前相比,患儿治疗后6、12、24、48 h及结束时血压有所升高,动脉血氧分压/吸入氧浓度、血pH增加;治疗后24、48 h和治疗结束时尿量增多,血钾、尿素氮、肌酐均显著下降;治疗后12 h肾上腺素维持剂量显著下降,差异均有统计学意义(P<0.05).治疗后48 h可停用肾上腺素.CBP治疗期间仅发生1例血滤膜堵塞,及时更换滤膜后继续透析治疗,未发生其他并发症.结论 CBP治疗新生儿重症脓毒症伴MODS具有可行性,可改善患儿循环功能及肾功能.Objective To study the clinical effects of continuous blood purification (CBP) in the treatment of newborns with severe sepsis and multiple organ dysfunction syndrome (MODS). Method From May 2013 to November 2018, the clinical data of infants with severe sepsis and MODS receiving CBP in the neonatal department of our hospital were retrospectively analysed. Changes of blood pressure, arterial partial pressure of oxygen/inhaled oxygen concentration (PaO2/FiO2), pH, serum potassium, sodium, urea nitrogen, creatinine, urine volume and maintenance dose of adrenaline at different time points before and after CBP were analysed. Result According to the inclusion and exclusion criteria, a total of 8 newborns with sepsis and MODS were enrolled in the study. One patient had the complication of perforated colon, and the other one had acute renal failure. The number of affected organs in these infants was 3~5. Six cases began CBP treatment within 1~5 days after admission, and the other two cases began CBP treatment on the 38th and 47th days after admission. The average treatment duration was (58.6±25.9) h. The effective rate of CBP in the treatment of severe sepsis with MODS was 75.0%(6/8). Blood pressure was increased at 6 h, 12 h, 24 h and 48 h after treatment and at the end of treatment. PaO2/FiO2 and blood pH were increased. The urine volume was increased at 24 h and 48 h after treatment and at the end of treatment (P<0.05). Serum potassium, urea nitrogen and creatinine were significantly decreased (P<0.05). The maintenance dose of adrenaline was also decreased significantly at 12 h after CBP (P<0.05), and withdrawn at 48 h after treatment. Only one case experienced membrane blockage during CBP. Dialysis was continued after the replacement of filtration membrane. No other complications existed. Conclusion CBP is effective in the treatment of neonatal severe sepsis with MODS. It can improve the circulation and renal function.

关 键 词：脓毒症 多器官功能衰竭 连续性血液净化 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]