连续性血液净化治疗儿童颅脑疾病合并高钠血症

Continuous blood purification for treatment of pediatric cerebral disease with hypernatremia

目的探索连续性血液净化（CBP）在儿童颅脑疾病合并高钠血症治疗中的应用价值。方法选择入住我院PICU的9例颅脑疾病合并高钠血症患儿行CBP治疗，根据血清钠水平调整置换液的钠浓度，观察高血钠与病情的关系及实施CBP前后血清钠浓度及纠正速度、血流动力学的变化。结果9例高钠血症患儿治疗后血清钠均有明显下降，与治疗前比较差异有统计学意义（P〈0．05），血清钠每日下降14．2mmol／L，血钠纠正速度为0．75mmol／（L·h），治疗过程安全，血流动力学稳定。4例死于多器官功能障碍综合征（MODS），1例放弃治疗，4例治愈出院。结论CBP治疗高钠血症效果确切，安全性好，尤其对颅脑疾病合并高钠血症者应尽早实施。

Objective To assess the value of continuous blood purification （CBP） for treatment of pediatric cerebral disease complicated by hypernatremia. Methods Nine children with cerebral disease and concurrent hypematremia admitted in the pediatric intensive care unit received CBP therapy. The sodium concentration in the exchange fluid was adjusted according to the serum sodium concentration. The correlation between the serum sodium concentration and the disease condition of the children was analyzed, and the changes in serum sodium and hemodynamics after CBP were observed. Results Nine children showed significantly decreased serum sodium after CBP therapy （P〈0.05）. No significant changes in the hemodynamics were observed during CBP in these children （P〈0.05）, whose disease condition remained stable. The serum sodium was decreased by 14.2 mmol/L daily, and lowered at the rate of 0.75 mmol/L per hour. Of the 9 children, 4 died of multiple organ dysfunction syndrome, 1 gave up the treatment, and 4 recovered, with a cure rate of 44.44%. Conclusion As a safe and effective treatment modality for critical patients with hypernatremia, CBP must be carried out as early as possible especially in patients with cerebral disease complicated by hypernatremia.