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目的评价持续静脉-静脉血液透析滤过(CVVHDF)治疗危重型手足口病患儿的临床效果。方法选取40例危重型手足口病患儿随机均分为常规治疗组及CVVHDF治疗组,CVVHDF组在常规治疗基础上加用CVVHDF治疗。观察治疗24h后患儿的呼吸、心率、平均动脉压等生命体征变化及IL-18、INF-α、IL-10、TGF-β1等细胞因子变化。结果治疗24h后,常规治疗组IL-18、INF-a炎性因子无明显下降,而IL-10、TGF-β1细胞因子下降(P<0.01);CVVHDF组IL-18、INF-α、IL-10、TGF-β1均较治疗前和常规治疗组治疗后下降(P<0.01);常规治疗组治疗24h后,呼吸、心率、平均动脉压等与治疗前相比无统计学差异(P>0.05),而CVVHDF组治疗24h后,呼吸、心率、平均动脉压等均较治疗前和常规治疗组治疗后改善(P<0.01)。结论 CVVHDF能有效改善危重型手足口病患儿临床症状,清除炎性细胞因子,降低抗炎细胞因子水平。
Objective To evaluate the clinical efficacy of continuous venovenous hemodiafiltration (CVVHDF) in the treatment of critically ill hand-foot-mouth disease in children. Methods Forty children with critical HFMD were randomly divided into routine treatment group and CVVHDF treatment group. CVVHDF group was treated with CVVHDF on the basis of routine treatment. The change of vital signs such as respiration, heart rate, mean arterial pressure and the changes of cytokines such as IL-18, INF-α, IL-10 and TGF-β1 were observed 24h after treatment. Results After treatment for 24 h, IL-18 and INF-a were not significantly decreased, but IL-10 and TGF-β1 cytokines were decreased in the conventional treatment group (P <0.01) (P <0.01). There was no significant difference in respiratory rate, heart rate and mean arterial pressure between the two groups before and after treatment (P> 0.05). In CVVHDF group, respiration, heart rate and mean arterial pressure were all improved after treatment (P <0.01). Conclusions CVVHDF can effectively improve the clinical symptoms, eliminate inflammatory cytokines and decrease the levels of anti-inflammatory cytokines in children with critically ill hand-foot-mouth disease.