连续性血液净化技术在儿童重症监护室中的应用

Application of Continuous Blood Purification in PICU

目的 总结连续性血液净化技术(CBP)在儿童重症监护室(PICU)患儿中的应用及效果。方法 回顾分析江西省儿童医院PICU 2015年12月至2021年12月收治的67例行CBP患儿的临床资料,分析CBP应用疾病种类,观察患儿CBP期间的并发症、预后及转归,比较肝、肾功能异常患儿CBP治疗前后的肝、肾功能。结果 67例患儿共行148例次CBP,其中连续性血液滤过(CVVH)56例次,连续性血液透析(CVVHD)6例次,血浆置换86例次。经治疗后痊愈20例、好转23例、放弃治疗出院13例、死亡8例、未愈3例,治愈好转率为64.18%。肝、肾功能异常患儿CBP治疗后的肝、肾功能均较治疗前有明显改善,差异有统计学意义(P<0.05)。常见并发症为低体温(128例次占62.13%)及电解质紊乱(61例次占29.61%),经处理后均顺利完成血液净化;有9例次因静脉壶凝血提早下机,无出血、心跳呼吸骤停等严重并发症。结论 CBP已广泛应用于儿科各种疾病,为一种安全有效的治疗方式。

Objective To summarize the application and efficacy of continuous blood purification(CBP)in pediatric patients in the pediatric intensive care unit(PICU).Methods The clinical data of 67 children who were admitted to the PICU of Jiangxi Children’s Hospital and treated with CBP from December 2015 to December 2021 were retrospectively analyzed.The types of diseases were analyzed,and the complications,prognosis and outcome during CBP were observed.The hepatic and renal functions of children with hepatorenal insufficiency were measured before and after CBP treatment.Results A total of 148 times of blood purification were performed in the 67 children,including 56 times of continuous veno-venous hemofiltration,6 times of continuous veno-venous hemodialysis,and 86 times of plasma exchange.After treatment,20 cases were cured,23 cases were improved,13 cases gave up treatment and were discharged from hospital,8 cases died,and 3 cases did not recover.The recovery rate was 64.18%.Furthermore,the hepatic and renal functions were significantly improved after CBP(P<0.05).The common complications were hypothermia(128 times,62.13%)and electrolytic disorder(61 times,29.61%).These children successfully completed blood purification after treatment.Nine cases underwent termination due to venous pot coagulation.No serious complications such as bleeding and cardiopulmonary arrest were found in all the children.Conclusion CBP is a safe and effective treatment that has been widely used in pediatric diseases.