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目的探讨连续性血液净化(CBP)联合血液灌流(HP)治疗儿童危重症合并急性肾衰竭(ARF)的疗效及安全性。方法 2009年4月-2010年8月在本院行CBP联合HP治疗的儿童危重症合并ARF患儿10例。选择连续性静脉-静脉血液透析滤过(CVVHDF)模式进行床旁CBP治疗,治疗时间持续8~36 h,同时序贯加用珠海丽珠医用生物材料有限公司HA系列树脂灌流器进行HP治疗,治疗时间2 h。观察治疗前后血BUN、血肌酐(SCr)、ALT、CK、电解质、CRP、内皮素(ET)、中心静脉压(CVP)、平均动脉压(MAP)、氧合指数[pa(O2)/FiO2]和血气分析等指标变化,采用SPSS 13.0软件进行统计学处理。结果 CBP联合HP治疗后血BUN、SCr、TB、ALT、CK明显降低;电解质、酸碱平衡紊乱得到纠正,CRP显著降低,pa(O2)/FiO2显著提高;治疗过程中血流动力学稳定,ET、HR及CVP较治疗前明显降低,差异均有统计学意义(Pa<0.05)。治愈6例,好转、放弃治疗各2例。结论 CBP联合HP治疗过程中,血流动力学稳定,有效纠正氮质血症和水电解质、酸碱平衡紊乱,是治疗儿童危重症合并ARF的一种安全、有效的方法。
Objective To investigate the efficacy and safety of continuous blood purification (CBP) and hemoperfusion (HP) in the treatment of critically ill children with acute renal failure (ARF) in children. Methods From April 2009 to August 2010, 10 children with critical illness and ARF were enrolled in this study. Continuous veno-venous hemodiafiltration (CVVHDF) mode was selected for bedside CBP treatment for 8 ~ 36 h. Meanwhile, HP series of resin-filled resin cartridges of Zhuhai Livzon Medical Biomaterial Co., Ltd. were used for HP treatment. Treatment time 2 h. Blood BUN, SCr, ALT, CK, electrolytes, CRP, ET, CVP, MAP and paO2 / FiO2 were observed before and after treatment. ] And blood gas analysis and other indicators of change, using SPSS 13.0 software for statistical analysis. Results The levels of BUN, SCr, TB, ALT and CK were significantly decreased after treatment with CBP plus HP. The electrolytes, acid-base balance disorders were corrected, CRP was significantly decreased and pa (O2) / FiO2 was significantly increased; hemodynamics was stable during treatment, ET, HR and CVP were significantly lower than before treatment, the differences were statistically significant (Pa <0.05). 6 cases were cured, improved, give up treatment in 2 cases. Conclusions During the course of CBP combined with HP, hemodynamic stability and effective correction of azotemia, aqueous electrolyte, acid-base balance disorders are a safe and effective method for the treatment of children with critically ill ARF.