早期连续血液净化治疗对儿童脓毒性休克预后的影响:前瞻性随机对照研究

Effect of early continuous blood purification on the prognosis of children with septic shock:a prospective randomized controlled clinical trial

目的探讨早期连续血液净化(CBP)治疗对儿童脓毒性休克预后的影响。方法前瞻性选择未达到6 h初期复苏目标和/或液体过负荷>10%的脓毒性休克患儿为研究对象,根据CBP治疗时间分为早期组(n=30)和常规组(n=28)。比较两组患儿的CBP开始时间、28 d病死率,两组治愈患儿的相关指标变化。结果早期组CBP开始时间早于常规组(P<0.05)。早期组治愈25例,常规组治愈22例,两组患儿28 d病死率比较差异无统计学意义(P>0.05)。早期组治愈患儿的乳酸、尿量和液体过负荷纠正时间快于常规组治愈患儿(P<0.05)。两组治愈患儿的初始T淋巴细胞亚群均明显降低,第7天复查均有升高,且早期组高于常规组(P<0.05)。早期组治愈患儿的CBP治疗持续时间、机械通气时间、PICU住院时间均短于常规组治愈患儿(P<0.05)。结论对未达到6 h初期复苏目标和/或液体过负荷>10%的脓毒性休克患儿早期行CBP治疗,能够快速控制病情,缩短病程,加快免疫重建。

Objective To study the effect of early continuous blood purification(CBP)on the prognosis of children with septic shock.Methods A prospective analysis was performed for the children with septic shock who did not reach the 6-hour initial recovery target and/or had a fluid overload of>10%.According to the treatment time of CBP,they were divided into an early group with 30 children and a conventional group with 28 children.The two groups were compared in terms of the start time of CBP and 28-day mortality rate,as well as the related indexes in the children who were cured.Results The early group had a significantly earlier start time of CBP than the conventional group(P<0.05).There were 25 children cured in the early group and 22 cured in the conventional group,and there was no significant difference in 28-day mortality rate between the two groups(P>0.05).The children who were cured in the early group had significantly shorter correction time of lactic acid,urine volume,and fluid overload than those in the conventional group(P<0.05).The children who were cured in both groups had significant reductions in the percentages of T-lymphocyte subsets at the beginning(P<0.05);on reexamination on day 7,the percentages of T-lymphocyte subsets were increased and were higher in the early group than in the conventional group(P<0.05).The children who were cured in the early group had significantly shorter duration of CBP treatment,duration of mechanical ventilation,and length of stay in the PICU than those in the conventional group(P<0.05).Conclusions For children with septic shock who do not reach the 6-hour initial recovery target and/or have a fluid overload of>10%,early CBP treatment can quickly control the disease,shorten the course of disease,and accelerate immune reconstruction.