连续血液净化对儿童严重脓毒症预后的影响

Effects of continuous blood purification on prognosis of severe sepsis in children

目的探讨连续血液净化(CBP)治疗对儿童严重脓毒症预后的影响。方法选择2014年1月至2016年1月入住西安市儿童医院重症监护病房(PICU)并被确诊为严重脓毒症的患儿共86例作为本次的研究对象。按照是否行血液净化治疗将患儿分为血液净化组和非血液净化组,每组患儿各有43例。收集并比较两组患儿治疗前后的p H异常率、电解质紊乱率、乳酸、谷丙转氨酶(ALT)、谷草转氨酶(AST)、尿素氮(BUN)、血肌酐(Scr)、小儿危重病例评分(PCIS)、病死率等指标。结果血液净化组与非血液净化组治疗后的p H异常率、电解质紊乱率、乳酸、ALT、AST、BUN、Scr、PCIS评分均优于治疗前(血液净化组χ~2/t值分别为32.45、34.58、14.65、31.63、32.90、18.09、8.24、7.29;非血液净化组χ~2/t值分别为23.35、13.35、8.10、24.38、28.89、8.12、5.14、3.55,均P<0.05),且治疗后血液净化组上述指标优于非血液净化组(χ~2/t值分别为18.68、8.14、7.81、11.98、10.01、10.99、2.53、2.57,均P<0.05)。血液净化组的病死率(6.98%)低于非血液净化组(27.91%),χ~2=6.54,P<0.05。结论 CBP可以有效地改善严重脓毒症患儿的内环境和脏器功能,降低病死率,改善预后。

Objective To explore the effects of continuous blood purification（ CBP） on prognosis of severe sepsis in children. Methods Totally 86 children diagnosed with severe sepsis and admitted in pediatric intensive care unit（ PICU） in Xi＇an Children＇s Hospital from January 2014 to January 2016 were selected as subjects in the study. They were divided into blood purification group and non-blood purification group（ 43 cases in each group） according to whether CBP was conducted. The indicators of abnormal rate of PH,electrolyte disturbance rate,lactic acid,ALT,AST,BUN,Scr,pediatric critical illness score（ PCIS） and mortality were recorded before and after treatment in two groups for comparison. Results Abnormal rate of PH,electrolyte disturbance rate,lactic acid,ALT,AST,BUN,Scr and PCIS were all improved in two groups after treatment compared to those before treatment（ χ^2/t value was 32. 45,34. 58,14. 65,31. 63,32. 90,18. 09,8. 24 and 7. 29,respectively in blood purification group; χ^2/t value was 23. 35,13. 35,8. 10,24. 38,28. 89,8. 12,5. 14 and 3. 55,respectively in non-blood purification group,all P〈0. 05）. In addition,a more significant improvement in the above indicators was observed in blood purification group compared with non-blood purification group after treatment（ χ^2/t value was 18. 68,8. 14,7. 81,11. 98,10. 01,10. 99,2. 53 and 2. 57,respectively,all P〈0. 05）. The mortality（ 6. 98%） in blood purification group was significantly lower than that（ 27. 91%） in non-blood purification group（ χ^2= 6. 54,P〈0. 05）. Conclusion CBP can improve internal environment and organic function effectively,reduce mortality and improve prognosis in children with severe sepsis.