连续性血液净化治疗小儿急性呼吸窘迫综合征

Effect of continuous venovenous hemodiafiltration （CVVHDF） on children with acute respiratory distress syndrome

目的探讨连续血液透析滤过（CWHDF）对急性呼吸窘迫综合征（ARDS）患儿氧合、血流动力学以及凝血功能的影响。方法2004年1月至2007年11月复旦大学附属儿科医院收治的11例ARDS患儿为研究对象。所有患儿接受机械通气等治疗，同时行CVVHDF，于治疗前（0h），治疗后2h（2h）、4h（4h）、6h（6h）记录患儿心率（FIR）、平均动脉压（MAP），采血测动脉血气；于治疗前（0h），治疗后2h（2h）、6h（6h）采血行血小板计数、D-二聚体和血浆纤维蛋白原检测。各指标各时点间比较采用Stata7．0软件行数据统计分析。结果所有患儿于CVVHDF前均存在氧合指数低、低血压、心率偏快，D-二聚体增高。经CVVHDF治疗后，患儿心率、血压、氧合指数好转，各时点间比较差异有显著性（P〈0．05）。治疗中患儿血小板计数进行性下降，D-二聚体降低，各时点间比较差异有显著性（P〈0．05）。结论CVHDF能有效改善ARDS患儿氧合和稳定血流动力学；对凝血功能无显著不利影响。

Objective To investigate the effect of CVVHDF on children with acute respiratory distress syndrome （ARDS）. Methods Eleven patients with ARDS from Jan 2004 to Dec 2007 admitted to Children＇s Hospital of Fudan University underwent CVVHDF. Before CVVHDF（0 h） and two hours （2 h） ,four hours （4 h） and six hours（6 h） after CVVHDF,we recorded the HR ,MAP and detected blood gas together with the blood platelet count, D-dimer and fibrinogen. Results Eleven patients with ARDS presented with low PaO2/FiO2 ,low MAP and fast heart rate, the D-dimer values were higher than that of before CVVHDF. After receiving the treatment of CVVHDF, their HR,MABP,P/F and D-dimer value improved gradually at 2 h,4 h and 6 h. Conclusion CVVHDF has an effect on improving the oxygenation and the hemodynamics of the patients. It has ,however, no side effect on the coagulation of the children with ARDS.