连续性血液净化治疗儿童严重脓毒症的疗效观察

Efficacy of continuous blood purification in the treatment of severe sepsis in children

目的探讨连续性血液净化(CBP)治疗严重脓毒症患儿的疗效和机制。方法选取42例严重脓毒症患儿为研究对象,根据是否实施血液净化治疗分为对照组(12例)和血液净化组(30例),对照组根据脓毒症指南接受一般的内科治疗,血液净化组在接受一般治疗的同时加入CBP治疗。观察两组患儿入组时(治疗前)及治疗后72 h时各指标的变化。结果血液净化组患儿的心率、平均动脉压和脑利钠肽治疗前-治疗后差值均比对照组明显升高(P均<0.05);血液净化组的氧合指数、24 h平均尿量、血尿素氮、血肌酐和格拉斯哥昏迷评分差值分别比相应对照组明显升高(P均<0.05)。血液净化组的毛细血管再充盈时间、血乳酸和中心静脉血氧饱和度差值分别比对照组明显升高(P均<0.05)。血液净化组的白细胞计数、C-反应蛋白、降钙素原和白细胞介素-6差值分别比对照组明显升高(P均<0.05)。两组患儿小儿危重病例评分治疗后-治疗前差值比较,差异有统计学意义(P<0.05)。血液净化组病死率明显降低,两组患儿病死率比较差异有统计学意义(P<0.05)。结论应用CBP治疗儿童严重脓毒症可改善心血管功能、脑功能、肾功能、组织灌注、内环境、炎症指标,并能提高小儿危重病例评分得分,降低病死率,有一定疗效。

Objective To evaluate the efficacy and mechanism of continuous blood purification(CBP)in the treatment of severe sepsis in children.Methods A total of 42 patients with severe sepsis wereenrolled in the study.According to the parents undefined desire to treatment,on the basis of the sametreatment condition,30 cases in the blood purification group were treated with CBP,and 12 cases in thecontrol group were given the routine treatment without CBP treatment.The difference of each index betweenthe two groups at the baseline(before treatment)and 72 hours after treatment were observed.Results Thedifferences of heart rate,mean arterial pressure and brain natriuretic peptide before and after treatment in theblood purification group were significantly higher than those in control group(P<0.05),and the differencesof oxygenation index,24-hour average urine volume,blood urea nitrogen,creatinine and Glasgow coma scorein the blood purification group were significantly higher than those in control group(P<0.05).Thedifference of capillary refill time,lactic acid and central venous oxygen saturation in blood purification groupwere significantly higher than those in control group(P<0.05).The level of white blood cell count,C-reactive protein,procalcitonin and interleukin-6 in blood purification group were significantly higher thanthose in control group,with all significant difference(P<0.05).There was significant difference in criticalillness score between two groups after treatment and before treatment.The mortality rate of the bloodpurification group was significantly lower than that in control group(P<0.01).Conclusion CBP canimprove cardiovascular function,brain function,renal function,tissue perfusion,inflammation index,internalenvironment,and improve the score of children with severe sepsis.