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目的探讨连续性血液净化技术(CBP)在急性肾衰竭(ARI)及ARI合并多脏器功能衰竭(MODF)患儿中使用效果。方法回顾性分析海南省人民医院1999年至2010年体质量8 kg以上患儿17例,其中男性14例,女性3例;年龄1～14岁,平均年龄6.3岁;体质量8～71 kg,平均体质量25.8 kg,10 kg以下仅3例。行41例次CBP治疗,重点观察治疗中不同儿童死亡风险(PRISMⅡ)评分、不同体质量、不同临床干预(血管活性药使用与否、机械通气有无、不同超滤率)患儿死亡率和血流动力学变化。结果PRISMⅡ评分>10分、有机械通气患儿的死亡率比PRISMⅡ评分≤10分、无机械通气患儿高(P<0.05)。体质量>26 kg组死亡率、低血压发生率与体质量≤26 kg组相比,差异无统计学意义(P>0.05),但体质量低于26 kg组平均动脉压(MAP)、平均心率(HR)、升压药使用频率显著高于体质量>26 kg组(P<0.05)。超滤率大于/小于2 mL/(kg.h)两组MAP、HR、升压药使用频率差异无统计学意义(P>0.05)。结论体质量8 kg以上儿童运用预充量52 mL滤器行CBP治疗只要预充得当,合理范围超滤率下可以避免严重血流动力学波动,安全救助患儿;需要CBP治疗的多脏器功能不全综合征(MODS)患儿死亡率在PRISMⅡ评分>10分、有机械通气、使用血管活性药物者较高。
Objective To investigate the effect of continuous blood purification (CBP) in children with acute renal failure (ARI) and ARI complicated with multiple organ failure (MODF). Methods A retrospective analysis of Hainan Provincial People’s Hospital from 1999 to 2010 in 17 patients with body weight 8 kg or more, including 14 males and 3 females; aged 1 to 14 years, mean age 6.3 years; body weight 8 to 71 kg, The average body mass 25.8 kg, 10 kg following only 3 cases. 41 cases of CBP were treated in this study. The PRRSII score, different body weight, different clinical interventions (with or without vasoactive agents, different mechanical ventilation rate and different ultrafiltration rate) Hemodynamic changes. Results PRISM Ⅱ score> 10 points, children with mechanical ventilation had a higher mortality rate than those with PRISM Ⅱ score ≤10 and children without mechanical ventilation (P <0.05). There was no significant difference in the mortality rate and the incidence of hypotension between the groups with body weight> 26 kg and the body weight ≤ 26 kg (P> 0.05), but the mean arterial pressure (MAP) Heart rate (HR), vasopressor use frequency was significantly higher than the body mass> 26 kg group (P <0.05). There was no significant difference in the frequency of MAP, HR and vasopressor between the two groups with ultrafiltration rate greater than / less than 2 mL / (kg.h) (P> 0.05). Conclusion Children with body weight above 8 kg use pre-filled 52 mL filter for CBP treatment. As long as the pre-filling is appropriate, severe hemodynamic fluctuation can be avoided under the reasonable range of ultrafiltration rate, and children are safely rescued. The multiple organ function requiring CBP treatment Mortality in children with incomplete syndrome (MODS) PRISM Ⅱ score> 10 points, with mechanical ventilation, the use of vasoactive drugs were higher.