CAJ | 학술논문

目的探讨连续血液净化治疗(CBP)在PICU危重患儿中的应用价值.方法实施CBP治疗患儿18例,其中急性肾功能衰竭14例,行连续静脉-静脉血液滤过(CVVH)治疗;另外2例瑞氏综合征、2例吉兰-巴雷综合征患儿行血浆置换(PE)治疗.观察治疗前后患儿临床症状、血生化、血气指标及氧合的变化情况.结果 14例急性肾功能衰竭患儿CVVH治疗后血清尿素氮(BUN)、肌酐(Scr)明显下降[(48.6±14.8)mmol/L vs(28.9±5.4)mmol/L;(634.3±258.2)μmol/L vs(318.4±143.5)μmol/L],血钾、pH值基本维持正常范围,氧合也有明显的改善.14例患儿中12例肾功能恢复正常.2例吉兰-巴雷综合征患儿经PE治疗后呼吸困难、肌力明显改善,顺利撤离呼吸机.2例瑞氏综合征患儿PE治疗后ALT、AST、血氨明显下降,经包括PE在内的综合抢救治疗后好转出院.CBP治疗并发症:穿刺口渗血3例,体温不升2例.治疗过程中患儿生命体征稳定,未见血压、脉搏异常波动.结论 CBP对急性肝、肾功能衰竭及自身免疫性疾病危重患儿的治疗安全有效.
목적 탐토련속혈액정화치료(CBP)재PICU위중환인중적응용개치.방법 실시CBP치료환인18례,기중급성신공능쇠갈14례,행련속정맥-정맥혈액려과(CVVH)치료;령외2례서씨종합정、2례길란-파뢰종합정환인행혈장치환(PE)치료.관찰치료전후환인림상증상、혈생화、혈기지표급양합적변화정황.결과 14례급성신공능쇠갈환인CVVH치료후혈청뇨소담(BUN)、기항(Scr)명현하강[(48.6±14.8)mmol/L vs(28.9±5.4)mmol/L;(634.3±258.2)μmol/L vs(318.4±143.5)μmol/L],혈갑、pH치기본유지정상범위,양합야유명현적개선.14례환인중12례신공능회복정상.2례길란-파뢰종합정환인경PE치료후호흡곤난、기력명현개선,순리철리호흡궤.2례서씨종합정환인PE치료후ALT、AST、혈안명현하강,경포괄PE재내적종합창구치료후호전출원.CBP치료병발증:천자구삼혈3례,체온불승2례.치료과정중환인생명체정은정,미견혈압、맥박이상파동.결론 CBP대급성간、신공능쇠갈급자신면역성질병위중환인적치료안전유효.
Objective To investigate the application of continuous blood purification in the children with critical diseases. Methods Eighteen critical patients aged 1 ～ 15 years in PICU underwent continuous blood purification(CBP). Fourteen with acute renal failure (ARF) were treated with continuous veno-venous hemmofiltration(CVVH) ,2 with Guillain-Barre syndrome and 2 with Raye's syndrome were treated with plasma exchange(PE). The changes of clinical symptoms, blood biochemistry , blood gas, and oxygenation were analyzed before and after CBP. Results After CVVH treatment, the BUN and creatinine of 14 patients with ARF were decreased from (48.6 ± 14. 8) mmol/L to(28. 9 ±5.4) mmol/L and (634. 3 ±258. 2) μ mol/L to (318.4 ± 143.5) μmol/L,K+ and pH of serum were maintained in the normal range,oxygenation was significantly improved. Breathing difficulties and muscle strength in 2 patients with GBS were ameliorated and successfully weaned from ventilator after PE. Serum ALT,AST and ammonia of 2 cases with Raye's syndrome decreased significantly and they discharged after comprehensive treatment including PE. Bleeding in puncture region were found in 3 patients, hypothermia in 2 patients. During the treatment, vital signs of patients were stable,blood pressure and pulse were not fluctuated. Conclusion CBP is an effective and safe method in the treatment of critical diseases in children.