血浆置换在儿童危重症中的应用

The clinical application of plasma exchange therapy in critically ill children

目的探讨血浆置换在儿童危重症中应用的疗效及安全性。方法经股静脉或颈内静脉建立血管通路,应用Prisma血液净化机,对10例PICU危重患儿进行28次血浆置换治疗。患者病种分别为脓毒症合并多脏器功能不全、急性肝功能衰竭、肾移植后急性排斥反应,溶血尿毒综合征、格林-巴利综合征、狼疮性肾炎,所有病例均存在2～5个脏器功能衰竭。结果每次血浆置换量为(63.5±19.5)ml/kg,血流速度为5～10ml/(kg·min),置换速度为血流速度的20%～25%。经过血浆置换及综合治疗,10例患儿临床症状及生化指标均有好转,2例分别进行4次血浆置换治疗病情才得到缓解。结果8例存活,2例死亡(急性肝功能衰竭及狼疮性肾炎各1例)。28例次均顺利完成血浆置换治疗。治疗中有3例次发生一过性荨麻疹,未见休克、严重出血倾向、感染等严重并发症。结论血浆置换是治疗儿童严重脓毒症及免疫性疾病的一种有效措施。

Objective To explore the clinical application, effects and safety of plasma exchange （PE） therapy on critical diseases in children. Methods Ten severe patients with 28 PE treatments were retrospectively reviewed. Lumen catheter was inserted into the femoral or jugular vein, and the PRISMA blood purification machine was used. The primary diseases included sepsis combined with multiple organs dysfunction, acute liver failure （ALF）, acute rejection after renal transplantation, hemolytic uremic syndrome （HUS）, Guillain-Barre syndrome （GBS） and lupus nephritis respectively. Multiple organs （2 - 5 ） failure occurred in all patients. Results The average total plasma exchange volume was 63.5 ±19.5 ml/kg, achieved with blood flow rate of 5 ±10 ml/（kg.min） and turnover rate at 20%±25% of blood flow rate. All patients＂ clinical symptoms and biochemical indexes were improved with two of them received 4 PE treatments before the improvement was observed. Eight patients were survived and discharged, while the other two deceased （1 ALF and 1 lupus nephritis）. Twenty-eight PE treatments completed smoothly and three of them experienced transient urticaria with no severe complications as shock, serious bleeding tendency or infections. Conclusions Plasma exchange therapy is a good choice for pediatrics critical sepsis and immune disease.