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目的探讨血液净化技术(BP)在小儿危重症治疗中的并发症和意外事件的防治方法。方法2004-03—2006-03,对广州市儿童医院儿科中心监护室(PICU)危重患儿实施血液净化治疗,并进行危险因素的监控与防治。结果(1)对16例入选患儿进行了BP治疗,共32次。存活12例,死亡4例,治疗过程中死亡和治疗后24h内死亡分别为1例和3例。(2)BP治疗前后炎症指标如体温、心率、呼吸、WBC计数、ESR、CRP下降,差异均有显著性(P值<0.001)。(3)在32次BP治疗术中出现各类并发症28次。发生次数最多的是循环系统并发症包括血压明显下降、不稳、休克或高血压共10次,其他并发症有穿刺点出血不止、血肿或全身出血,低温,肺氧合功能明显恶化,肺出血;意外事件发生6次,包括滤器堵塞、血浆分离器漏血等。(4)BP治疗术中也有酸碱平衡失调、血清电解质紊乱等并发症。经过床边监护和相应治疗大部分并发症和全部意外事件得以纠治。结论危重患儿实施血液净化治疗时存在各种危险因素,全程监控可保障治疗安全并可及时纠治并发症和全部意外事件。
Objective To investigate the methods of prevention and treatment of complication and accident of blood purification (BP) in pediatric critically ill patients. Methods From March 2004 to March 2006, blood purification was performed on critically ill children in Pediatric Center Nursing Clinic (PICU) in Guangzhou Children’s Hospital. Risk factors were monitored and controlled. Results (1) A total of 32 cases were treated with BP in 16 infants. Survival in 12 cases, 4 deaths, death during treatment and death within 24h after treatment were 1 case and 3 cases respectively. (2) The indexes of inflammation before and after BP treatment such as body temperature, heart rate, respiration, WBC count, ESR and CRP decreased, the difference was significant (P <0.001). (3) There were 28 kinds of complications in 32 BP treatments. The most frequent occurrences of circulatory complications include a marked drop in blood pressure, instability, shock or high blood pressure for a total of 10 times. Other complications include bleeding at the puncture point, hematoma or systemic bleeding, hypothermia, and significant deterioration of pulmonary oxygenation, pulmonary hemorrhage ; 6 accidents occurred, including filter blockage, plasma separator leakage and so on. (4) BP treatment of acid-base balance disorders, serum electrolyte disorders and other complications. After bedside guardianship and the corresponding treatment of most complications and all accidents can be corrected. Conclusion There are various risk factors in the treatment of critically ill children with blood purification. The full monitoring can ensure the safety of treatment and promptly correct the complications and all the unexpected events.