连续性血液净化技术在儿童严重脓毒症治疗中的价值研究

The value of continuous blood purification in the treatment of severe sepsis in children

目的探讨连续性血液净化(CBP)技术在治疗儿童严重脓毒症中的效果及临床应用价值。方法选取2017-06-10-2020-06-10泰安市中心医院儿科重症监护病房收治的102例严重脓毒症患儿。根据家属意愿将患儿分为观察组(53例)及对照组(49例)。2组患儿均按照《2012版儿童严重脓毒症与脓毒性休克治疗国际指南》原则给予相应治疗。观察组除接受常规治疗外,还给予连续静脉-静脉血液滤过(CVVH)治疗,对出现急性肝衰竭者给予治疗性血浆置换术(TPE)+CVVH治疗。采用t检验、方差分析等统计学方法分析2组在住院时间、机械通气时间及死亡率之间的差异;分析2组在治疗前、后的临床体征、炎症指标、脏器功能指标及小儿危重症评分(PCIS)的变化。结果观察组的机械通气时间、死亡率均低于对照组,差异有统计学意义,均P<0.05。2组的住院时间差异无统计学意义,均P>0.05。观察组PCIS在治疗后第1、第2、第3和第5天时均有改善,与对照组比较,差异有统计学意义,均P<0.05。观察组的体温(T)、C反应蛋白(CRP)、降钙素原(PCT)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBil)、血尿素氮(BUN)、血肌酐(Scr)、肌酸激酶同工酶(CKMB)、心肌肌钙蛋白I(CTnI)等指标在治疗后第1、第2、第3和第5天均明显下降,与对照组比较,差异有统计学意义,均P<0.05。观察组心率(HR)及平均动脉压(MBP)在治疗后第2、第3和第5天与对照组比较改善明显,差异有统计学意义,均P<0.05;观察组乳酸(Lac)在治疗第3和第5天时较治疗前改善明显,与对照组比较,差异有统计学意义,均P<0.05;2组治疗后的白细胞(WBC)变化无明显差异,差异无统计学意义,均P>0.05。结论CBP可以改善严重脓毒症患儿的临床症状及脏器功能,减少机械通气时间,降低死亡率,其临床效果优于传统治疗方法,有积极的临床应用价值。

Objective To investigate the effect and clinical value of continuous blood purification(CBP)in the treatment of severe sepsis in children.Methods A total of 102 children with severe sepsis admitted to the pediatric Intensive Care Unit of Tai’an Central Hospital from June 10,2017 to June 10,2020 were selected.According to the wishes of family members,the children were divided into observation group(53 cases)and control group(49 cases).The 2 groups were given corresponding treatment according to the international Guidelines for the Treatment of Severe Sepsis and Septic Shock in Children 2012.In addition to conventional treatment,the observation group also received continuous veno-venous hemofiltration(CVVH)treatment.Patients with acute liver failure were treated with therapeutic plasma replacement(TPE)+CVVH.T test,variance analysis,and other statistical methods were used to analyze the difference between the two groups in the length of hospital stay,mechanical ventilation time and mortality.The changes of clinical signs,inflammatory indexes,organ function indexes and pediatric critical illness score(PCIS)in both groups were analyzed before and after treatment.Result The duration of mechanical ventilation and mortality in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the length of hospital stay between the two groups(P>0.05).PCIS in the observation group were significantly improved on 1 d,2 d,3 d and 5 d after treatment,and the differences were statistically significant compared with the control group(P<0.05).Body temperature(T),C-reactive protein(CRP),procalcitonin(PCT),glutamic-pyruvic transaminase(ALT),glutamic-oxaloacetic transaminase(AST),total bilirubin(TBil),blood urea nitrogen(BUN),serum creatinine(Scr),creatine kinase isoenzyme(CKMB)and cardiac troponin I(CTnI)and other indicators decreased significantly on 1d,2d,3dand 5dafter treatment,and the differences were statistically significant compared with the control group(P<0.05).The heart rate(HR)and mean arterial pressure(MBP)of the observation group were significantly improved compared with the control group at 2d,3dand 5dafter treatment,and the differences were statistically significant(P<0.05).Lactic acid(Lac)in the observation group was significantly improved on the 3rd and 5th day after treatment compared with the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the changes of white blood cells(WBC)between the two groups after treatment(P>0.05).Conclusions CBP can improve the clinical symptoms and organ functions of children with severe sepsis,reduce the time of mechanical ventilation,and reduce mortality.Its clinical effect is superior to that of traditional treatment methods,and it has positive clinical application value.