连续性血液滤过治疗儿童多器官功能障碍综合征疗效研究

The clinical efficacy of continuous veno-venous hemofiltration for multiple organ dysfunction syndrome in children

目的 探讨连续性静脉-静脉血液滤过疗法（Continuous veno-venous hemofiltration,CVVH）治疗儿童脓毒症（Sepsis）并多器官功能障碍综合征（Multiple organ dysfunction syndrome,MODS）的临床疗效.方法 30例脓毒症并MODS患儿分成治疗组15例与对照组15例,均给予抗生素、血管活性药物、营养对症支持治疗、维持水电解质酸碱平衡、机械通气,治疗组患儿除上述治疗外,进行CVVH治疗.治疗组分别取治疗前0 h、开始24 h、48h检测血清细胞因子TNF-α,IL-1,IL-6,同时比较治疗0 h、48 h心率、平均动脉压、呼吸机参数、生化、血气分析指标以及小儿危重病例评分（Pediatric Critical Illness Score,PICS）,对照组检测治疗0h、48h的TNF-α,IL-1,IL-6水平,并比较两组的PIGS变化及28d存活率.结果 治疗组TNF-α在治疗24h（52.32±24.66）pg/ml、48 h（45.28±25.18） pg/ml,明显低于治疗0 h（64.46±28.0）pg/ml（P＜0.05） IL-1在治疗24 h（25.29±3.81）pg/ml、48 h（21.54±2.40）pg/ml,明显低于治疗0h（28.54±5.44）pg/ml IL-6在治疗24h（158.06±50.29）pg/ml、48h（104.05±59.42）pg/ml,明显低于治疗0 h（197.76±51.18）pg/ml（P＜0.05）.患儿循环、呼吸及内环境稳定指标较治疗前明显好转（P＜0.05）,PCIS评分治疗前为（70.05±12.55）分、治疗后为（79.5±4.83）分（P＜0.05） 治疗组患儿28 d存活率高于对照组（治疗组73.33%,对照组46.67%）.结论 运用CVVH治疗儿童MODS可以迅速有效地清除细胞因子,纠正内环境紊乱,改善患者的预后.

Objective To investigate the efficacy of continuous veno-venous hemofiltration （CVVH）for children with multiple organ dysfunction syndrome （MODS）. Methods 30 chilren were divide into treatment group （15 cases） and control group （15 cases） and received antibiotics,vasoactive drugs,nutritional therapy,maintenance of acid-base balance,and mechanical ventilation the treatmetn group received additional CVVH. Serum levels of cytokines （TNF-α,IL-1,and IL-6） were detected at 0,24,and 48h in the treatment group,and at 0 and 48h in the control group. Mean arteril pressure,ventilator parameters,biochemical indices,blood gas analysis,and PCIS of were determined before and after treatment. 28-day survival rate was compared between the two groups. Results TNF-α and IL-6 were decreased at 24h and 48h and IL-1 was at 48h the difference was significant （P〈0.05）. The indices of circulatory,respiratory,and internal environment stability were obviously improved after treatment （P〈0.05）. PCIS score increased （P〈0.05）. 28day survival rate was significanfly higer than in the treatment group than in the control group. Conclusions CVVH can effectively remove serum TNF-α,IL-1,and IL-6 in children with MODS,correct disturbance of the internal environment,and improve prognosis.