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目的了解中国儿科血液净化技术2012年至2016年的发展情况。方法采用横断面调查方案,选择中华医学会和中国医师协会儿科急救或重症学组成员单位为调查医院,基于2012年相同调查问卷修改完善《CBP应用现状调查表》(简称调查表),调查内容:(1)调查医院性质、规模和PICU床位数;(2)各项血液净化技术开展情况:腹膜透析(IPD)、血液透析(IHD)、连续肾脏替代治疗(CRRT)、血浆置换技术(TPE)、血液灌流(HP)、血液吸附(PA)和人工肝支持(ALSS);(3)CBP救治病种及并发症的分布情况,对调查医院统一培训后完成填写。结果 2016年12月30日至2017年3月30日28个省中39个城市53/55家医院完成调查表填写,儿科专科医院39家,综合性医院14家,三级甲等医院49家;均有PICU病房,PICU平均床位数25张。开展CRRT的23家医院共有6 618例;开展TPE的32家医院2 580例,开展HP的23家医院2 238例,开展ALSS的20家医院开展961例。应用各项技术的病例数呈逐年增加趋势,IPD所占比例呈下降趋势。CBP各技术的实施80%以上的医院以ICU为主,其次为肾内科;CBP主要应用于脓毒症24.3%,MODS 20.3%,药物中毒12.7%等的治疗。9家医院已开展新生儿CBP技术,共46例新生儿接受CBP治疗。5年间共有1 093例肝功能衰竭患儿应用CBP的治疗,各模式成活率HP 85.7%,TPE+HP 72.0%,TPE 70.5%、CRRT 69.8%,TPE+CRRT模式50.0%。CBP的主要并发症为深静脉置管吸壁、堵膜等。结论 2012年至2016年CBP技术在全国儿童重症领域得到很大推广,尤其在脓毒症等疾病的应用方面。
Objective To understand the development of pediatric blood purification technology from 2012 to 2016 in China. Methods The cross-sectional investigation was used to select the members of the Chinese Medical Association and Pediatric First Aid or Critical Care Unit of the Chinese Medical Association as the research hospitals. The questionnaire of 2012 revised and perfected “CBP Status Quo” (survey) (2) The development of various blood purification technologies: peritoneal dialysis (IPD), hemodialysis (IHD), continuous renal replacement therapy (CRRT), and plasmapheresis (TPE) ), Hemoperfusion (HP), blood adsorption (PA) and artificial liver support (ALSS); (3) CBP treatment of diseases and the distribution of complications, the completion of a unified training hospital survey completed. Results From December 30, 2016 to March 30, 2017 53/55 hospitals in 39 cities of 28 provinces completed the questionnaire completed, including 39 pediatric special hospitals, 14 general hospitals and 49 first-class hospitals ; Have PICU ward, PICU average number of beds 25. There were 6,618 cases in 23 CRRT-performing hospitals, 2,580 in 32 hospitals carrying out TPE, 2,238 in 23 hospitals carrying out HPE, and 961 in 20 hospitals carrying out ALSS. The number of cases applying various techniques showed an increasing trend year by year, and the proportion of IPD showed a decreasing trend. More than 80% of the CBP implementation of the hospital ICU-based, followed by the Department of Nephrology; CBP is mainly used in the treatment of sepsis 24.3%, MODS 20.3%, drug poisoning 12.7%. Nine hospitals have conducted neonatal CBP technology, a total of 46 newborns receiving CBP treatment. In the 5 years, a total of 1 093 children with liver failure were treated with CBP. The survival rates of each model were 85.7% for HP, 72.0% for TPE + HP, 70.5% for TPE, 69.8% for CRRT and 50.0% for TPE + CRRT. The main complication of CBP for deep vein suction pipe wall, blocking and so on. CONCLUSIONS: CBP has been widely promoted in pediatric intensive care across the country from 2012 to 2016, especially in the areas of sepsis and other diseases.