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目的观察连续血液净化(CBP)对儿童脓毒性休克的疗效并探讨其机理。方法用CBP的连续性静-静脉血液滤过模式治疗了9例脓毒性休克患儿,检测CBP治疗前及治疗中各时相点血气、生化、中分子物质浓度等指标及毛细血管再充盈时间(CRT)、血管活性药物用量、血压、尿量等临床症状、体征变化。结果9例脓毒性休克患儿体重3．1～14kg(平均8．3 kg±3．5kg),治疗时合并急性肾功能衰竭6例、急性呼吸窘迫综合征3例、细菌血培养阳性5例,全部需升压药维持血压。CBP治疗前pH7．14±0．23,BE(-11．3±4．25)mmol/L,MMS(3532±519)U/L,PO_2/FiO_2 188±33,CRT≥5s,尿量(0．85±0．52)ml/(kg·hr),肾上腺素用量(1．36±0．48)μg/(kg·min),多巴胺用量16．35±3．27μg/(kg·min)。CBP治疗24h后pH 7．38±0．16,BE(-0．28±1．37)mmol/L,MMS (2576±375)U/L,PO2/FiO_2 285±63,肾上腺素用量(0．08±0．04)μg/(kg·min),多巴胺用量(8．53±6．72)μg/(kg·min),CRT＜2s,治疗结束时尿量(2．9±1．6)ml/(kg·hr)。与CBP治疗前比均(P＜0．05)或(P＜0．01)差异有统计学意义。经过3～12d的治疗,2例死于MODS(肠套叠并肠坏死1例、大面积烫伤1例),1例肠扭转术后肠漏放弃治疗,6例治愈出院。结论CBP联合其他综合治疗可明显提高脓毒性休克患儿的氧合能力、纠正酸中毒、稳定血压、改善组织器官灌注、清除中分子物质,值得进一步研究和应用。
Objective To observe the curative effect of continuous blood purification (CBP) on septic shock in children and explore its mechanism. Methods Nine children with septic shock were treated with continuous venovenous hemofiltration (CBP) of CBP. Blood gas, biochemical and molecular substance concentrations were measured at various time points before and during CBP treatment, and capillary recharging time (CRT), the amount of vasoactive drugs, blood pressure, urine output and other clinical symptoms and signs. Results Nine children with septic shock had a body weight of 3.1-14 kg (mean 8.3 kg ± 3.5 kg). Six patients with acute renal failure, three patients with acute respiratory distress syndrome and five patients with positive bacterial blood culture , All need to vasopressors to maintain blood pressure. Before CBP treatment, the average value of pH was 7.14 ± 0.23, BE (-11.3 ± 4.25) mmol / L, MMS (3532 ± 519) U / L, PO_2 / FiO_2 188 ± 33, CRT≥5s, 0.85 ± 0.52) ml / (kg · hr), epinephrine (1.36 ± 0.48) μg / (kg · min), dopamine dosage 16.35 ± 3.27μg / (kg · min ). After 24h CBP treatment, the pH value was 7.38 ± 0.16, BE (-0.28 ± 1.37) mmol / L, MMS (2576 ± 375) U / L, PO2 / FiO_2 285 ± 63, .08 ± 0.04 μg / kg · min, dopamine dose 8.53 ± 6.72 μg / kg · min, CRT less than 2 s. The urine output at the end of treatment was 2.9 ± 1. 6) ml / (kg · hr). Compared with CBP before treatment (P <0.05) or (P <0.01) the difference was statistically significant. After 3 to 12 days of treatment, 2 patients died of MODS (intussusception and intestinal necrosis in 1 case, extensive scalding in 1 case), 1 case of intestinal leakage after the intestine to give up treatment, 6 cases were cured. Conclusion CBP combined with other comprehensive treatment can significantly improve oxygenation in children with septic shock, correct acidosis, stabilize blood pressure, improve tissue perfusion, removal of medium molecular, worth further study and application.