小儿连续性血液净化中动态血气监测临床研究

Clinical study of dynamic blood gas monitoring on pediatric continuous blood purification

目的探讨动态血气监测在小儿连续性血液净化治疗中的方式及对疗效的影响。方法回顾性分析本院2012年8月~2015年10月收治的40例连续性血液净化患儿临床数据,给予规范密切的动态血气监测分析,比较治疗前后的血气指标变化,分析不良反应情况。结果治疗24 h、72 h及治疗结束后的天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、血氨（NH3）、肌酸激酶同工酶（CK-MB）、总胆红素（TBi L）、肌酐（Cr）、尿素氮（BUN）、活化部分凝血活酶时间（APTT）水平显著低于治疗前,治疗结束后的ALT、AST、CK-MB、TBi L、Cr、BUN、NH3、APTT水平显著低于治疗24 h后,差异有统计学意义（P〈0.05）。在血液净化过程中,4例发生明显的血压异常降低,均由密切的动态血气监测分析及时发现并积极升压控制,避免了血液净化意外中断,保证了生命安全及最终的综合净化效果。其余患儿治疗初始阶段均有较小的血压等指标波动趋势,均在后期经过血液流量及超滤量调整得到回升,恢复正常。结论动态血气监测能作为灵活准确的生命体征分析依据及疗效评价依据,建议在小儿连续性血液净化中积极配合应用。

Objective To explore the way of dynamic blood gas monitoring and its influence on pediatric continuous blood purification.Methods Clinical data from 40 cases of pediatric continuous blood purification in our hospital from August 2012 to October 2015 were retrospectively analyzed.The standardized and close observation on dynamic blood gas monitoring was given.The change of blood gas indexes before and after therapy was compared and adverse reaction was analyzed. Results The level of aspartate aminotransferase（AST）,alanine aminotransferase（ALT）,creatine kinase（CK-MB）,total bilirubin（TBi L）,creatinine（Cr）,blood urea nitrogen（BUN）,activated partial thromboplastin time（APTT）,and ammonia（NH3） after treatment for 24,72 hours and the end of treatment was lower than that before treatment,the level of AST,ALT,CK-MB,TBi L,Cr,BUN,APTT,and NH3 in the end of treatment was lower than that after treatment for 24 hours,with significant difference（P〈0.05）.There were 4 cases with abnormal decrease of blood pressure in the process of blood purification,which were timely detected by close observation on dynamic blood gas monitoring and controlled after taking measures of elevating blood pressure,undesirable interruption of blood purification was avoided,and life safety and final comprehensive purified effect were ensured.Fluctuation trend of blood pressure in a small range was existed at an early stage in other participants and was risen and returned to normal via regulation on blood flow rate and ultrafiltration volume at a later stage.Conclusion Dynamic blood gas monitoring can be used as flexible and accurate analysis basis of vital signs and therapeutic evaluation basis.It is recommended to use for cooperation in pediatric continuous blood purification.