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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。
OBJECTIVE: To compare the effects of common clinical treatments and continuous veno-venous hemofiltration (CVVH) with continuous renal replacement therapy (CRRT) on the liver-kidney function and blood gas analysis in children with severe sepsis, To observe the therapeutic effect of CVVH on severe sepsis in children. Methods 21 cases of severe sepsis in children. The patients were randomly divided into control group (n = 10), liquid resuscitation, anti-infective, mechanical ventilation, vasoactive drugs and other symptomatic supportive therapy as needed. CVVH group (n = 11) The onset of toxicity, plus CVVH treatment more than 48 h. Blood samples were collected from 1.5 mL venous blood at 4 h, 0 h, 12 h, 24 h and 48 h after operation, and the blood levels of BUN, Cr and ALT were compared between the two groups at the same time Arterial blood gas analysis was performed at 4 time points. The pH value, lactic acid (Lac) and base excess (BE) were compared and statistically analyzed. Results There was no significant difference in ALT, BUN, Cr, pH, Lac and BE levels between the control group and the 0 h group after 48 h of treatment. There was no significant difference between the CVT group and the control group at 48 h Statistically, BUN and BE decreased significantly compared with 0 h (Pa <0.05). There was significant difference between Cr and Lac at 0 h and 24 h (P <0.05) at 48 h. Compared with the control group, Lac in CVVH group decreased significantly at 24 h after treatment (P <0.05), and the levels of BUN, Cr and Cr in 48 h CVVH group were significantly lower than those in control group The control group decreased significantly, the differences were statistically significant (Pa <0.05); 2 ALT, pH value difference was not statistically significant. Conclusion CVVH combined with comprehensive treatment can significantly improve renal function in children with severe sepsis and multiple organ dysfunction syndrome and correct metabolic acidosis.