中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2012年
3期
188-192
,共5页
张育才%徐梁%戎群芳%朱艳%陈容欣
張育纔%徐樑%戎群芳%硃豔%陳容訢
장육재%서량%융군방%주염%진용흔
呼吸障碍%血液透析滤过%肺顺应性%儿童
呼吸障礙%血液透析濾過%肺順應性%兒童
호흡장애%혈액투석려과%폐순응성%인동
Respiration disorders%Hemodiafiltration%Lung compliance%Child
目的 探讨床旁持续性血液净化(continuous blood purification,CBP)治疗在救治危重病儿童急性肺损伤和急性呼吸窘迫综合征(acute lung injury/acute respiratory distress syndrome,ALI/ARDS)中作用.方法 2006年6月至2011年5月,我院共收治ALI/ARDS患儿147例,对其中32例在常规治疗基础上进行CBP治疗.模式为连续性静-静脉血液滤过透析(continuous vein-vein hemodialysis/filtration,CVVHDF),置换液+透析液剂量为35 ～100 ml/(kg·h).观察CBP治疗患儿呼吸指数( FiO2/PO2)、动态肺顺应性(Cdyn)、血气指标、机械通气参数、血管活性药物剂量和肺部X线等指标变化,比较病死率.结果 143例中,男89例(60.5％),女58例(39.5％),平均年龄(43.4±36.7)个月.死亡54例,总病死率为36.7％.ALI/ARDS原因主要为重症肺炎、严重脓毒症和白血病及肿瘤性疾病.CBP治疗组病情程度评分较非CBP治疗组严重,PRISMⅢ分别为15.3和12.7(P＜0.05),儿童危重评分分别为66.8 ±19.3和74.6±17.7(P ＜0.05).CBP治疗平均持续时间为52 h(12～232 h).CBP治疗后2 h PaO2/FiO2和Cdyn有改善,较治疗前比较差异有统计学意义(P＜0.05),X线见肺部渗出减轻,呼吸机参数中吸入氧指数(FiO2)吸气峰压(PiP)和呼吸末正压(PEEP)可以下调,合并MODS或休克患儿血管活性药物剂量逐渐下调.CBP治疗组和非CBP治疗组病死率分别为37.5％和36.5％,差异无统计学意义(P＞0.05),两组平均机械通气时间差异无统计学意义(P＞0.05).结论 CBP辅助治疗ALI/ARDS患儿可以减轻肺水肿,改善PaO2/FiO2和Cdyn,及时下调机械通气参数,达到改善肺部病变的作用,可能是ALI/ARDS治疗有发展潜力的治疗手段.
目的 探討床徬持續性血液淨化(continuous blood purification,CBP)治療在救治危重病兒童急性肺損傷和急性呼吸窘迫綜閤徵(acute lung injury/acute respiratory distress syndrome,ALI/ARDS)中作用.方法 2006年6月至2011年5月,我院共收治ALI/ARDS患兒147例,對其中32例在常規治療基礎上進行CBP治療.模式為連續性靜-靜脈血液濾過透析(continuous vein-vein hemodialysis/filtration,CVVHDF),置換液+透析液劑量為35 ～100 ml/(kg·h).觀察CBP治療患兒呼吸指數( FiO2/PO2)、動態肺順應性(Cdyn)、血氣指標、機械通氣參數、血管活性藥物劑量和肺部X線等指標變化,比較病死率.結果 143例中,男89例(60.5％),女58例(39.5％),平均年齡(43.4±36.7)箇月.死亡54例,總病死率為36.7％.ALI/ARDS原因主要為重癥肺炎、嚴重膿毒癥和白血病及腫瘤性疾病.CBP治療組病情程度評分較非CBP治療組嚴重,PRISMⅢ分彆為15.3和12.7(P＜0.05),兒童危重評分分彆為66.8 ±19.3和74.6±17.7(P ＜0.05).CBP治療平均持續時間為52 h(12～232 h).CBP治療後2 h PaO2/FiO2和Cdyn有改善,較治療前比較差異有統計學意義(P＜0.05),X線見肺部滲齣減輕,呼吸機參數中吸入氧指數(FiO2)吸氣峰壓(PiP)和呼吸末正壓(PEEP)可以下調,閤併MODS或休剋患兒血管活性藥物劑量逐漸下調.CBP治療組和非CBP治療組病死率分彆為37.5％和36.5％,差異無統計學意義(P＞0.05),兩組平均機械通氣時間差異無統計學意義(P＞0.05).結論 CBP輔助治療ALI/ARDS患兒可以減輕肺水腫,改善PaO2/FiO2和Cdyn,及時下調機械通氣參數,達到改善肺部病變的作用,可能是ALI/ARDS治療有髮展潛力的治療手段.
목적 탐토상방지속성혈액정화(continuous blood purification,CBP)치료재구치위중병인동급성폐손상화급성호흡군박종합정(acute lung injury/acute respiratory distress syndrome,ALI/ARDS)중작용.방법 2006년6월지2011년5월,아원공수치ALI/ARDS환인147례,대기중32례재상규치료기출상진행CBP치료.모식위련속성정-정맥혈액려과투석(continuous vein-vein hemodialysis/filtration,CVVHDF),치환액+투석액제량위35 ～100 ml/(kg·h).관찰CBP치료환인호흡지수( FiO2/PO2)、동태폐순응성(Cdyn)、혈기지표、궤계통기삼수、혈관활성약물제량화폐부X선등지표변화,비교병사솔.결과 143례중,남89례(60.5％),녀58례(39.5％),평균년령(43.4±36.7)개월.사망54례,총병사솔위36.7％.ALI/ARDS원인주요위중증폐염、엄중농독증화백혈병급종류성질병.CBP치료조병정정도평분교비CBP치료조엄중,PRISMⅢ분별위15.3화12.7(P＜0.05),인동위중평분분별위66.8 ±19.3화74.6±17.7(P ＜0.05).CBP치료평균지속시간위52 h(12～232 h).CBP치료후2 h PaO2/FiO2화Cdyn유개선,교치료전비교차이유통계학의의(P＜0.05),X선견폐부삼출감경,호흡궤삼수중흡입양지수(FiO2)흡기봉압(PiP)화호흡말정압(PEEP)가이하조,합병MODS혹휴극환인혈관활성약물제량축점하조.CBP치료조화비CBP치료조병사솔분별위37.5％화36.5％,차이무통계학의의(P＞0.05),량조평균궤계통기시간차이무통계학의의(P＞0.05).결론 CBP보조치료ALI/ARDS환인가이감경폐수종,개선PaO2/FiO2화Cdyn,급시하조궤계통기삼수,체도개선폐부병변적작용,가능시ALI/ARDS치료유발전잠력적치료수단.
Objective To investigate the efficacy of continuous blood purification (CBP)in the treatment of acute lung injury/acute respiratory distress syndrome ( ALI /ARDS ) in children.Methods One hundred and forty seven cases of ALI/ARDS were hospitalized to our pediatric intensive care unit,and 32 cases were treated with continuous blood purification (CBP) from June,2006 to May,2011.The model for CBP was continuous veno-venous hemofiltration dialysis (CVVHDF).CBP treatment persisted for at least 8 hours and replacement + dialysis fluid dose was 35-100 ml/( kg · h). The clinical outcome measures included the mortality rate at 28th day,respiratory index ( FiO2/PO2 ),dynamic lung compliance ( Cdyn),arterial partial pressure of oxygen ( PaO2 ),arterial partial pressure of carbon dioxide ( PaCO2 ),mechanical ventilation parameters,vasoactive drug dose and lung X-ray changes.Results In totally 147 cases of ALI/ARDS,89 cases (60.5％ ) were male and 58 ( 39.5％ ) were female,mean age was (43.4 ± 36.7 )months.Death occurred in 54 cases,the total mortality was 36.7％.The cause of ALI/ARDS was mainly severe pneumonia,severe sepsis,and leukemia or tumor diseases. There were significant differences in severity of illness between the CBP treatment group and non-CBP treatment group on Pedialric risk of score mortality ( PRISM ) Ⅲ score ( 15.3 vs.12.7,P ＜ 0.05 ) and pediatric critical illness score ( 66.8 ± 19.3 vs.74.6 ± 17.7,P ＜0.05).The average duration of CBP treatment was 52 hours ( 12 hours to 232 hours).PaO2/FiO2 and Cdyn were improved after 2 hours CBP treatment compared with those before CBP treatment (P ＜ 0.05 ),mechanical ventilation parameters including fraction of inspired oxygen (FiO2 ),peak inspiratory pressure (PiP) and positive end expiratory pressure (PEEP) were reduced. The use of vasoactive drugs in patients with MODS and shock gradually declined.The average ventilator-free days of the two groups did not show significant difference (P ＞ 0.05).The mortality on CBP treatment group and nontreatment group were 37.5％ and 36.5％,respectively,the difference was not significant (P ＞ 0.05 ).Conclusion CBP adjuvant treatment for ALI/ ARDS could reduce pulmonary edema,improve PaO2/FiO2and Cdyn,and improve mechanical ventilation parameters.CBP may be a very promising treatment for ALI/ARDS in children.
