小儿溶血尿毒综合征21例临床分析

目的:探讨小儿溶血尿毒综合征(HUS)的临床特点和治疗方法.方法:回顾性分析2003年1月至2011年7月重庆医科大学附属儿童医院收治的21例溶血尿毒综合征患儿的临床表现、辅助检查和治疗方法.结果:HUS多见于幼儿及学龄儿童,部分病例起病前有呼吸道感染或腹泻,以不同程度的溶血性贫血、血小板减少和急性肾功能不全为典型临床表现.急性期采取综合治疗,包括抗感染、抗凝血、输血、糖皮质激素、丙种球蛋白、血液净化等.本组病例急性期均存活,溶血得到控制,肾及其他脏器功能大多恢复正常.结论:HUS的诊断主要依靠对病史、临床表现和辅助检查结果进行综合分析.早期诊断和恰当的治疗是挽救HUS患儿生命的关键.在急性期采用对症治疗为主的综合措施,糖皮质激素、丙种球蛋白对严重溶血的重症病例有一定疗效.对于重症HUS患儿,早期联合应用血液净化治疗可以迅速控制病情,改善症状.

Clinical Analysis of 21 Children with Hemolytic Uremic Syndrome

Objective: To explore the clinical features and therapeutic strategy for children with hemolytic uremic syndrome(HUS).Methods: Clinical features,auxiliary examination results and therapeutic strategy of twenty-one patients with HUS treated from January,2003 to July,2011 in the Children’s Hospital of Chongqing Medical University were included and retrospectively reviewed.Results: The disease mainly affected pre-school and school-age children.Before the onset of the disease,some of the cases had respiratory tract infection or diarrhea,with varying degrees of hemolytic anemia,thrombocytopenia,and acute renal insufficiency for typical clinical manifestation.In the acute phase comprehensive treatment were given,including anti-infection,anticoagulation,blood transfusion,glucocorticoid and purification.All patients survived the acute phase;hemolysis was controlled;and the function of their kidneys and other organs recovered.Conclusions: The diagnosis of HUS mainly relies on the history,clinical features,and laboratory results analysis.Early diagnosis and proper treatments are the keys for HUS children.During the acute stage,the comprehensive measures of symptom-relieving treatment should be adopted.Glucocorticoid and immunoglobulin have certain curative effects for severe hemolytic cases.For some patients early combined use of blood purification treatment can control the illness quickly and improve symptoms.