不同剂量置换液连续血液净化治疗小儿急性呼吸窘迫综合征的临床效果影响研究

Clinical Effect Comparison of different dose Replacement Fluid CBP in Treating ARDS Children

目的:比较常规剂量置换液与高剂量置换液连续血液净化(CBP)治疗急性呼吸窘迫综合征(ARDS)的临床疗效。方法:选取58例ARDS患儿作为研究对象,按照随机数字表法将患者分为研究组和对照组,每组29例。研究组给予高剂量置换液[50~70ml/(kg·h)]连续血液净化治疗,对照组给予常规剂量置换液[20~35ml/(kg·h)]连续血液净化治疗。比较两组患儿连续血液净化时间、入住PICU时间、机械通气时间;比较两组不同时间动脉血氧分压、动脉二氧化碳分压、氧合指数、呼吸频率;比较治疗前后患儿危重病例评分、第3代小儿死亡风险评分及治疗期间不良事件发生率。结果:研究组连续血液净化时间、入住PICU时间、机械通气时间均比对照组短,组间差异具有统计学意义(P<0.05)。治疗前,两组动脉血氧分压、动脉二氧化碳分压、氧合指数、呼吸频率比较,差异均无统计学意义(P>0.05);治疗后24h,研究组动脉氧分压、氧合指数显著高于对照组,差异有统计学意义(P<0.05),两组动脉二氧化碳分压、呼吸频率比较,差异无统计学意义(P>0.05);治疗后48h,研究组动脉氧分压、氧合指数显著高于对照组,差异有统计学意义(P<0.05),研究组动脉二氧化碳分压显著低于对照组,差异有统计学意义(P<0.05),两组呼吸频率比较,差异无统计学意义(P>0.05)。两组治疗后100h,研究组小儿危重病例评分高于对照组,差异有统计学意义(P<0.05),两组第三代小儿死亡风险评分比较,差异无统计学意义(P>0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:高剂量置换液CBP治疗小儿ARDS在起效时间、改善呼吸功能等方面存在一定优势,但考虑到治疗不良反应等因素,临床需根据实际情况合理选择最优治疗方案。

Objective To compare clinical effect between conventional dose replacement fluid CBP and high dose replacement fluid CBP in treating ARDS. Method 58 cases of ARDS children were selected as the study object,they were randomly divided into research group and control group according to random number table Method,29 cases each group.All patients were treated with mechanical ventilation treatment.Research group were treated with high dose replacement fluid CBP[50~ 70 ml/(pg.h)],while control group were treated with conventional dose replacement fluid CBP[20~35 ml/(kg.h)].The duration of CBP therapy,mechanical ventilation time,length of stay in PICU,oxygenation index,afterial blood oxygen tension,partial pressure of carbon dioxide,respiratory rate,pediatric critical illness score,pediatric risk of mortality and adverse events of two groups were compared. Results The duration of CBP therapy,mechanical ventilation time,length of stay in PICU of research group were shorter than control group ( P <0.05).Before treatment,there was no significant difference between two groups in oxygenation index,PO2,PaCO2,RR( P >0.05).24 h after treatment,The oxygenation index,PO2 of research group were higher than control group ( P < 0.05).There was no significant difference between two groups in PaCO2,RR ( P >0.05).48 h after treatment,The oxygenation index,PO2 of research group were higher than control group,and PaCO2 was lower ( P <0.05).There was no significant difference between two groups in RR ( P >0.05).100 h after treatment,The pediatric critical illness score of research group were higher than control group ( P <0.05).There was no significant difference between two groups in adverse events rate and pediatric risk of mortality ( P >0.05). Conclusion High dose replacement fluid CBP treatment has exact effect in working time and improving respiratory function for ARDS children.Considering adverse events,the CBP mode should depend on patients′ condition.