连续性血液净化治疗小儿急性肺损伤的临床研究

Clinical study of continuous blood purification in treatment of acute lung injury

目的探讨连续性血液净化(CBP)在治疗小儿急性肺损伤(ALI)中的作用。方法将2010年6月至2012年4月在河北省儿童医院重症医学监护科(PICU)住院符合ALI诊断标准的患儿纳入本研究,在综合治疗基础上进行CBP,观察患儿呼吸力学、血流动力学、氧合指数、炎症介质、血乳酸水平、电解质及脏器功能的变化。结果 ALI患儿经CBP治疗后,静态肺顺应性、氧合指标较前改善。呼吸道阻力、肿瘤坏死因子α、白细胞介素1(IL-1)明显降低,治疗前与治疗后各项指标分别为(4.48±2.35)kPa.s-1.L-1 vs(3.88±2.12)kPa.s-1.L-1、(429.60±284.71)pg/L vs(254.72±102.21)pg/L、(39.37±10.29)μg/L vs(12.47±2.83)μg/L(均P<0.05);IL-4、IL-10分别为(19.56±8.17)pg/L vs(40.12±19.29)pg/L、(14.39±8.45)pg/L vs(31.92±20.59)pg/L(均P<0.05);CRP、血乳酸水平降低,肝功能、肾功能、心肌酶指标较前改善,差异有统计学意义(P<0.05);但血压、心率、射血分数及电解质Na+、K+、CO2CP经CBP治疗后差异无统计学意义(P>0.05)。结论 CBP治疗ALI患儿,可有效清除炎症因子,改善患儿呼吸力学、氧合指数、脏器功能(肝功能、肾功能、心肌酶),但对血流动力学及内环境无明显影响。

Objective To investigate the effect of continuous blood purification（CBP） in acute lung injury（ALI）.Methods The patients who were diagnosed ALI in our hospital between 2010-06 and 2012-04 were internalized in our study.On the basis of combined modality therapy,the diversity of breathing mechanics,hemodynamics,oxygenation index,the level of inflammatory factor,lactic acid,electrolyte and the function of important organs of ALI children were observed.Results After CBP treatment in ALI children,static compliance of lung,oxygenation index improved.Airway resistance,tumor necrosis factor-α,interleukin-1（IL-1） in comparison between pre-and post-CBP treatment showed sigificant decrease,respectively,（4.48±2.35）kPa·s^-1·L^-1s（3.88±2.12）kPa·s^-1·L^-1429.60±284.71） pg/L vs（254.72±102.21） pg/L,（39.37±10.29） μg/L vs（12.47±2.83） μg/L.But IL-4 and IL-10 raised significantly,（19.56±8.17） pg/L vs（40.12±19.29） pg/L,（14.39±8.45） pg/L vs（31.92±20.59） pg/L.CRP,lactic acid,liver function,renal function and myocardial enzyme also significantly showed decrease.But there were no statistical discrepancy in blood pressure,heart rate,ejection fraction,Na^＋,K^＋ and CO2CP（P〉0.05）.Conclusion CBP treatment is good for cleaning inflammatory factors and improving breathing mechanics,oxygenation index and the function of important organ in ALI patients,but it has no significant influence on hemodynamics and homoiostasis.