连续性血液净化机在儿童多脏器功能障碍综合征救治中的应用

Application of continuous blood purification machine in treatment of multiple organs dysfunction syndromes in children

目的:观察连续性血液净化机在救治儿童多脏器功能障碍综合征(MODS)中的应用效果。方法:选取行连续性血液净化(CBP)治疗的26例MODS患儿,记录患儿治疗时间、置换液用量及超滤出液体量等,监测患儿CBP治疗前、后的血压和心率的变化情况,观察和比较患儿CBP治疗前、后的血尿素氮(BUN)和血肌酐(SCr)等肾功能指标,pH值、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、碳酸氢根(HCO_3^-)、碱剩余(BE)等血气指标以及钠离子(Na^+)、钾离子(K^+)、氯离子(Cl^-)以及渗透压等电解质指标的变化情况。结果:126例MODS患儿平均治疗时间为(77±53)h,置换液平均用量为(18.4±15.8)L/d,平均超滤出液体量为(2630±1760 ml/d)。所有患儿在CBP治疗过程中生命体征平稳,治疗前、后血压和心率无明显变化;2患儿经CAP治疗后BUN和SCr与治疗前相比明显下降,差异有统计学意义(t=50.392,t=96.115;P<0.05),pH值、氧合指数(PaO_2/FiO_2)、HCO_3^-及BE等血气指标均有明显改善,差异有统计学意义(t=4.450,t=20.105,t=11.209,t=54.840;P<0.05),Na^+、K^+、Cl^-及渗透压无明显变化,均能维持在正常范围。结论:CAP治疗能够有效减少各种炎性介质和毒素含量,改善肾功能,稳定机体内环境,是治疗MODS患儿安全、有效及可靠的方法。

Objective：To observe the application effect of continuous blood purification（CBP） machine in treatment of multiple organs dysfunction syndromes（MODS） in children.Methods： 26 cases of children with MODS implemented CBP therapy were choosed as the research objects. All the patient’s treatment time, replacement liquid dosage, the quantity of liquid ultrafiltration were recorded. All the patient’s blood pressure and heart rate were monitored before and after CBP therapy. The changes in the renal function indices such as BUN and SCr, the blood gas indexes such as pH, PaO2, PaCO2, HCO3-and BE, the electrolyte indicators such as Na＋, K＋, Cl- and osmotic pressure were observed and compared before and after CBP therapy.Results： （1）The average period of treatment of 26 cases in children with MODS was （77±53）h. The average amount of fluid replacement was （18.4±15.8）L/d, and the average quantity of liquid of ultrafiltration was （2630±1760）ml/d. The vital signs of all the children were stable in the process of CBP therapy, and the blood pressure and heart rate had no obvious changes before and after treatment. （2）The renal function indices such as BUN and SCr decreased obviously after treatment. The differences were statistically significant （t=50.392,t=96.115;P〈0.05）. The blood gas indexes such as PH, PaO2/FiO2, HCO3- and BE were improved significantly after treatment （t=4.450,t=20.105,t=11.209,t=54.840;P〈0.05）. The electrolyte indicators such as Na＋, K＋, Cl- and osmotic pressure had no obvious change after treatment （P〉0.05）.Conclusion： CBP therapy can effectively reduce various inflammatory mediators and toxin, improve renal function, help to stabilize the environment in the body and it is an effective, safe and reliable therapeutic method in the treatment of children with MODS.