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目的采用持续血液净化(Continuous Blood Purification,CBP)救治儿童严重脓毒症合并脏器功能障碍,观察其临床疗效。方法对2003年8月—2005年8月,我院收治的22例儿童严重脓毒血症进行持续静脉静脉血液透析滤过(Continuous Vein-Vein Hemodialysis Filtration,CVVHDF),观察心率、血压、血管活性药物使用、自主呼吸频率、氧合指数的变化以及预后。结果22例均顺利置管并完成CBP,CBP持续时间为(64．4±34．5)h。CBP前均存在心动过速,CBP 4h下降(45±13)次/ min；CBP后,未休克的7例血压平稳；10例早期休克患儿CBP后血压维持正常,血管活性药物1～5h下调,2～8h撤除；5例难治性休克患儿CBP 4h后血压明显上升,升高幅度为(25．2±10．7)mm Hg (1mm Hg=0．133 kPa),8h恢复到该年龄正常水平,血管活性药物在CBP 2～8h下凋,4～16h停用,较早期休克患儿略延长。呼吸频率增加的患儿CBP 4h后自主频率减慢(7±4)次/min；合并呼吸衰竭患儿CBP前氧合指数(PO_2/FiO_2)为(177．7±53．1)mm Hg,CBP后4h上升至(341．0±60．2) mm Hg,(5．3±2．1)h全部达到正常；吸入氧浓度FiO_2 2～4h降至50%以内。危重评分入院时62．2±7．4,24h升高至危重评分86．6±9．0,提高24．5±10．8；CBP治疗后存活16例,存活率72．7%,治疗有效率90．9%。置换液采用改良Ports方案可导致血钙、血糖和血渗透压的升高。CBP在脓毒症患儿应用可能引起转流初期的血压轻度下降和转流过程中的出血现象。结论持续血液净化有改善严重脓毒血症儿童重要脏器的作用。
Objective To investigate the clinical efficacy of continuous blood purification (CBP) in the treatment of children with severe sepsis complicated with organ dysfunction. Methods Twenty-two children with severe sepsis admitted to our hospital from August 2003 to August 2005 were enrolled in Continuous Vein-Vein Hemodialysis Filtration (CVVHDF). Heart rate, blood pressure, Drug use, frequency of spontaneous breathing, changes in oxygenation index, and prognosis. Results All the 22 cases were well placed and completed CBP, CBP duration was (64.4 ± 34.5) h. Before CBP, tachycardia was present, and the CBP 4h decreased (45 ± 13) times / min. After CBP, the blood pressure of 7 patients without shock was stable. The blood pressure remained normal after CBP in 10 patients with early shock, and decreased from 1 to 5 hours , 2 ~ 8h removed; 5 children with refractory shock CBP blood pressure increased significantly after 4h, the increase rate of (25.2 ± 10.7) mm Hg (1mm Hg = 0.133kPa), 8h recovery to the The age of normal levels, vasoactive drugs in the CBP 2 ~ 8h withered, 4 ~ 16h disabled, compared with early shock children slightly longer. Children with respiratory rate increased spontaneous frequency slowed (7 ± 4) times / min after CBP for 4 hours. The antegrade oxygenation index (PO 2 / FiO 2) in children with respiratory failure was (177.7 ± 53.1) mm Hg, CBP increased to (341.0 ± 60.2) mm Hg at 4h and reached to (5.3 ± 2.1) h at all. The concentration of inspired oxygen (FiO_2) decreased to within 50% within 2-4 hours. The critically graded score increased from 62.2 ± 7.4,24h to critical score 86.6 ± 9.0, with an increase of 24.5 ± 10.8 on admission; 16 survived after CBP and the survival rate was 72.7% Effective rate of 90.9%. Replacement fluid using the modified Ports program can lead to elevated blood calcium, blood sugar and blood pressure. The use of CBP in children with sepsis may cause a slight decrease in blood pressure during the initial stage of the commutation and bleeding during the commutation. Conclusion Continuous blood purification can improve the function of important organs in children with severe sepsis.