连续性血液净化治疗小儿重症手足口病的临床研究

Research of continuous blood purification in the treatment of children with severe hand,foot and mouth disease

目的分析连续性血液净化治疗(CBP)在小儿重症手足口病中的应用价值。方法选取病情符合手足口病重症病例危重型的患儿30例,随机分为对照组(常规治疗组)和CBP治疗组,每组15例。对照组给予常规药物治疗、机械通气治疗;CBP治疗组在常规治疗基础上联合行连续性静脉—静脉血液滤过治疗。监测2组患儿治疗前和治疗24 h后心率、血压、血乳酸及左心室射血分数等指标的变化情况,同时比较2组存活病例的机械通气时间、平均住院时间。结果对照组存活病例平均机械通气时间为(15.4±2.7)d,平均住院时间(21.2±3.5)d;CBP平均机械通气时间为(11.4±1.9)d,住院时间(18.7±2.0)d。治疗24 h后,2组收缩血压均较治疗前明显降低(P<0.01或P<0.05)。治疗24 h,CBP组心率、静脉血乳酸明显低于治疗前(P<0.01);左心室射血分数较治疗前升高(P<0.05)。CBP组治疗24 h后心率、血乳酸、血压均低于对照组,左心室射血分数高于对照组(P均<0.05)。结论 CBP能降低小儿重症手足口病患儿的心率、血压、血乳酸值同时改善心功能,对进一步提高危重症病例的抢救成功率、改善预后具有积极意义。

Objective To investigate the application value of continuous purification in treatment of children with severe hand, foot and mouth disease. Methods 30 children with severe hand, foot and mouth disease were selected. They were randomly divided into conventional treatment group（ routine treatment group） and CBP group. 15 patients in eachgroup. The control group was treated with conventional medicine and mechanical ventilation, while the CBP treatment group received continuous veno venous hemofiltration treatment on the basis of routine treatment. The changes of heart rate, blood pressure, blood lactate and left ventricular ejection fraction for both of the 2 groups were measured before and after treatment for 24 h, and the mechanical ventilation time and average hospitalization time were compared between the 2 groups. Results The average mechanical ventilation time of the control group was （15.4 ± 2.7） d, the average hospitalization time was （21.2 ± 3.5 ） d; the average mechanical ventilation time was （ 11.4 ± 1.9 ） d, and the hospitalization time was （ 18.7 ± 2.0） d （CBP）. After 24 h treatment, systolic blood pressure of the two groups was significantly lower than before treatment （ P 〈 0.01 or P 〈 0.05 ）. After 24 hours＇ treatment, CBP group of heart rate and blood lactate was significantly lower than that before treatment （P 〈 0.01 ） ; left ventricular ejection fraction were increased compared with that of before treatment （ P 〈 0.05 ）. CBP group of heart rate, blood lactic acid and blood pressure after 24 h were lower than the control group;left ventricular ejection fraction was higher than the control group （P 〈 0.05 ）. Conclusion Heart rate, blood pressure, blood lactic acid of the children with severe hand foot and mouth disease could be reduced by CBP therapy. At the same time, the heart function was improved. It would be significant for Improving the success rate of rescue and prognosis.