连续静脉-静脉血液滤过对严重脓毒症患儿的治疗作用

目的通过对目前临床常用的一般治疗方法及加用连续肾脏替代治疗(CRRT)方案的连续静脉-静脉血液滤过(CVVH)方法对严重脓毒症患儿肝肾功能、血气分析影响的比较,观察CVVH对严重脓毒症患儿的治疗作用。方法严重脓毒症患儿21例。随机分为对照组(n=10),按需要给予液体复苏、抗感染、机械通气、血管活性药物及其他对症支持治疗;CVVH组(n=11),按需要给予上述治疗,自诊断严重脓毒症开始,加用CVVH治疗48 h以上。2组均从确诊开始,在0 h、12 h、24 h及48 h 4个时间点抽取静脉血1.5 mL行血生化检查,比较其在不同时间点血BUN、Cr、ALT水平,同时在此4个时间点行动脉血气分析,对pH值、乳酸(Lac)、碱剩余(BE)进行比较及统计学分析。结果对照组48 h内血ALT、BUN、Cr、pH值、Lac、BE水平与0 h时比较差异均无统计学意义;CVVH组经治疗48 h,ALT、pH值与0 h比较差异均无统计学意义,BUN、BE较0 h明显下降(Pa<0.05),24 h、48 h时间点Cr、Lac与0 h比较,差异均有统计学意义(Pa<0.05)。2组比较初始状态各参数间差异均无统计学意义;治疗24 h,CVVH组Lac较对照组下降明显,差异均有统计学意义(P<0.05);48 h CVVH组BUN、Cr、BE较对照组下降明显,差异均有统计学意义(Pa<0.05);2组ALT、pH值比较差异均无统计学意义。结论 CVVH结合综合治疗能明显改善严重脓毒症并多脏器功能障碍综合征患儿肾功能,纠正代谢性酸中毒。

Effect of Continuous Venovenous Hemofiitration for Treatment of Severe Sepsis in Children

Objective To evaluate the effect of continuous venovenous hemofiltration(CVVH) in the treatment of severe sepsis in children,though analyzing liver,renal functions and blood gas analysis in treatment of CVVH cases compared to the normal treatment method.Met-hods Twenty-one cases with severe sepsis were enrolled to the study.These cases were randomly divided into control group(n=10) and CVVH group(n=11).Fluid resuscitation,antibiotics,mechanical ventilation,vasoactive agents and other symptomatic treatments were used in both groups as needed.In CVVH group,the CVVH was given for at least 48 h since the patient was diagnosed as severe sepsis.Blood biochemistry and arterial blood gas were conducted to compare the urea nitrogen,creatinine,alanine transarninase,pH,lactic acid(Lac),buffuer excess(BE) level at the time of 0 h,12 h,24 h and 48 h.Results There was no significant difference in alanine aminotransferase(ALT),blood urea nitrogen(BUN),creatinine(Cr),pH,Lac and BE in control group between the time point 0 h and 48 h.In CVVH group,levels of ALT,pH showed no significant differences between the time point 0 h and 48 h,and significant difference was observed in BUN and BE(Pa<0.05).At the time of 24 h,48 h,Cr,Lac levels changed significantly compared to 0 h(Pa<0.05).There was no significant diffe-rence between the 2 groups at the 0 h.Lac level decreased significantly after 24 h in CVVH group,and BUN,Cr,BE levels decreased significantly after 48 h compared to the control group at the same time points(Pa<0.05),there was no significant difference between the 2 groups in ALT and pH.Conclusion The application of CVVH in severe sepsis children with multiple organ dysfunction syndrome can significantly improve the renal function and correct metabolic acidosis.