连续性静脉-静脉血液透析/滤过治疗儿童多器官功能障碍综合征

目的 探讨持续性静脉.静脉血液透析滤过(CVVHD/F)救治儿童严重感染,并评估疗效.方法 对2002年12月至2007年11月上海交通大学附属儿童医院收治的符合脓毒性休克及MODS诊断标准参考按国际脓毒症会议或我国小儿多器官功能衰竭(MOSF)诊断标准的19例脓毒性休克合并多器官功能障碍综合征(MOOS)进行CVVHD/F治疗.观察患儿的血液电解质、血气指标、尿量、血肌酐(Cr)及尿素氮(BUN)、血管活性药物使用、氧合指数等变化和预后.结果 19例患儿平均危重评分为(69.1±10.4)分;平均PRISM Ⅲ(12.66±7.85)分.平均CWHD/F治疗时间为92 h(16 h～480 h).CVVHD/F治疗12～24 h后,成人型呼吸窘迫综合征或肺水肿患儿FiO2/PO2、PCO2、PO2好转(P<0.05),24 h后血液K+、Na+、HCO-3恢复正常水平,48 h后Cr、BUN恢复正常范围.病死率为63.2%.结论 CVVHD/F治疗脓毒性休克合并NODS可以迅速纠正体液电解质紊乱、改善循环功能,清除Cr、BUN,减轻肺水肿、脐水肿等.

Continuous veno-venuous hemodialysis/filtration for the treatment of multiple organ dysfunction syndrome in pediatrics

Objective To investigate the efficacy of continuous veno-venuous hemodialysis/filtration(CVVHD/F) for the treatment of multiple organ dysfunction syndrome(MODS)caused by severe infection and to explore the mechanism in children.Method Nineteen cases of pediatric septic shock with MODS were treated with CVVHD/F in Children's Hospital Affiliated to Shanghai Jiaotong University from December 2002 to November 2007.The clinical data were studied including mortality rate,serum electrolytes,arterial partial pressure of oxygen (PO2),artery partial pressure of carbon dioxide(PCO2),FiO2/PO2,urine output,blood pressure,doses of vasoactive agents,Cr,BUN,etc.Results Cannulation and CVVHD/F were well performed in a total of 19 cases,with median age 33.4±36.5 months(from 3 months to 8 years) ,with their gender ratio of male(13 cases)to female (6 cases) to be 68.4% and 31.6%.The mean pediatric crifcal illness score(PCIS) was 69.1±10.4 and Median Pediatric Risk of Mortality score(PRMS Ⅲ)12.66±7.85,respectively.The duration of CWHD/F was 92 hours(ranged from 16 hours to480 hours).FiO2/PO2,PCO2,and PO2 were iraproved significantly after 12 to 24 hours CVVHD/F in patients with acute respiratory distress syndrome(ARDS) or lung edema (P<0.05).The concentrations of serum kalium,natrinm and HCO3- level resumed to well-balanced in 24 hours (P<0.05).The serum Cr and BUN were decreased to normal range(P<0.05).The mortality rate was 63.2%.Conclusions CVVHD/F was effective for treatment of septic shock with MODS in pediatric by improving oxygenation,maintaining normal serum electrolytes,conecting metabolic acidosis,increasing the tissue perfusion and eliminating the serum Cr and BUN.