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目的观察连续性静脉-静脉血液滤过(CVVH)对儿童多脏器功能障碍综合征(MODS)的治疗作用,并探讨其作用机制。方法 36例MODS患儿采用CVVH治疗,检测CVVH治疗前及治疗中各时相点血气、生化、中分子物质(MMS)浓度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 36例MODS患儿体质量3~29[(12.5±9.1)kg],治疗时合并急性肾衰竭26例,急性呼吸窘迫综合征8例,水肿15例,感染性休克21例(均需升压药维持血压),细菌血培养阳性12例,平均器官功能障碍数4.32个。CVVH治疗前pH7.21±0.23,BE(-10.30±3.87)mmol.L-1,MMS(3 622±531)U.L-1,氧合指数[pa(O2)/FiO2]171±59,21例合并休克患儿尿量(0.15±0.06)mL.kg-1.h-1,肾上腺素用量(1.31±0.38)μg.kg-1.min-1,多巴胺用量(15.74±3.56)μg.kg-1.min-1。CVVH治疗24 h后pH7.35±0.15,BE(-1.81±1.59)mmol.L-1,MMS(2 518±362)U.L-1,pa(O2)/FiO2258±67,肾上腺素用量(0.08±0.03)μg.kg-1.min-1,多巴胺用量(8.32±4.43)μg.kg-1.min-1,尿量增加至(0.57±0.21)mL.kg-1.h-1。经过3~12 d的治疗,除9例MODS患儿死亡(其中重症肺炎并急性呼吸窘迫综合征4例,新生儿脓毒症、肠坏死各2例,大面积烫伤1例),1例肠扭转坏死术后发生肠漏放弃治疗外,余26例均治愈出院,治愈率72.2%。结论 CVVH联合其他综合治疗可明显提高MODS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MMS。
Objective To observe the therapeutic effect of continuous veno-venous hemofiltration (CVVH) on multiple organ dysfunction syndrome (MODS) in children and to explore its mechanism. Methods Thirty - six children with MODS were treated with CVVH. The levels of blood gas, biochemical and molecular markers (MMS) and the time of capillary reperfusion (CRT), the amount of vasoactive drugs, the blood pressure, Urine and other clinical symptoms, signs of change. Results The quality of 36 children with MODS was 3 ~ 29 [(12.5 ± 9.1) kg], with 26 cases of acute renal failure, 8 cases of acute respiratory distress syndrome, 15 cases of edema and 21 cases of septic shock Pressure medicine to maintain blood pressure), bacterial blood culture positive in 12 cases, the average number of organ dysfunction 4.32. Before CVVH treatment, pH7.21 ± 0.23, BE (-10.30 ± 3.87) mmol.L-1, MMS (3622 ± 531) UL-1 and oxygenation index (paO2 / FiO2) The total amount of urine (0.15 ± 0.06) mL.kg-1.h-1, epinephrine (1.31 ± 0.38) μg.kg-1.min-1 and dopamine dose in the combined shock group (15.74 ± 3.56) 1.min-1. After 24 hours of treatment with CVVH, the average values of pH7.35 ± 0.15, BE (-1.81 ± 1.59) mmol.L-1, MMS2 518 ± 362 UL-1, paO2 / FiO2258 ± 67, 0.03) μg.kg-1.min-1, the amount of dopamine (8.32 ± 4.43) μg.kg-1.min-1 and urine volume increased to (0.57 ± 0.21) mL.kg-1.h-1. After 3 to 12 days of treatment, 9 patients died of MODS (including 4 cases of severe pneumonia and acute respiratory distress syndrome, 2 cases of neonatal sepsis, 2 cases of intestinal necrosis and 1 case of extensive scald) and 1 case of intestinal Twenty-four cases were cured and discharged, with a cure rate of 72.2%. Conclusion CVVH combined with other comprehensive treatment can significantly improve the oxygenation ability of children with MODS, correct acidosis, stabilize blood pressure, improve organ perfusion and clear MMS.