中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2014年
6期
358-361
,共4页
裴亮%刘春峰%许巍%文广富%王丽杰%李玖军
裴亮%劉春峰%許巍%文廣富%王麗傑%李玖軍
배량%류춘봉%허외%문엄부%왕려걸%리구군
急性肝功能衰竭%血浆置换%持续静静脉血液透析滤过%儿童
急性肝功能衰竭%血漿置換%持續靜靜脈血液透析濾過%兒童
급성간공능쇠갈%혈장치환%지속정정맥혈액투석려과%인동
Acute live failure%Plasma exchange%Continuous veno-venous hemodialysis filtration%Children
目的 探讨血浆置换(plasma exchange,PE)联合持续静静脉血液透析滤过(continuous veno-venous hemodialysis filtration,CVVHDF)治疗儿童急性肝功能衰竭(acute liver failure,ALE)的应用价值.方法 中国医科大学附属盛京医院PICU 2008年8月至2014年1月收治39例符合ALF诊断患儿,行PE联合CVVHDF治疗,治疗方法为PE后立即进行CVVHDF,每次PE+ CVVHDF历时24~72h,治疗前后采集患儿凝血酶原时间、血氨、谷丙转氨酶、谷草转氨酶、血氨总胆红素、直接胆红素等指标,并对35例存在肝性脑病患儿治疗前后进行Glasgow昏迷评分.结果 39例患几经PE+ CVVHDF治疗后20例ALF患儿(51.3%)肝功能恢复正常出院,7例治疗过程中死亡,12例因个人原因治疗过程中放弃治疗,后电话随访死亡.经PE+ CVVHDF治疗后,患儿总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶分别较治疗前下降[(128.8 ±82.6) μmol/L vs (73.2±92.4) μmol/L;(90.2±71.5)μmol/L vs (55.1±42.6)μmol/L;(3 024.1±2457.0)U/L vs(1 256.8 ±757.8)U/L;(3 420.6±2216.3)U/L vs (579.4±338.6)U/L] (P <0.05);治疗后凝血酶原时间较治疗前缩短[(40.4±23.0)s vs(22.8±9.4)s](P<0.0l),临床出血倾向明显减轻;Glasgow昏迷评分明显升高[(9.5±3.1)分vs (12.1±2.9)分](P<0.01).结论 PE联合CVVHDF治疗小儿ALF可明显改善临床症状及生化指标,安全性好,无明显不良反应.
目的 探討血漿置換(plasma exchange,PE)聯閤持續靜靜脈血液透析濾過(continuous veno-venous hemodialysis filtration,CVVHDF)治療兒童急性肝功能衰竭(acute liver failure,ALE)的應用價值.方法 中國醫科大學附屬盛京醫院PICU 2008年8月至2014年1月收治39例符閤ALF診斷患兒,行PE聯閤CVVHDF治療,治療方法為PE後立即進行CVVHDF,每次PE+ CVVHDF歷時24~72h,治療前後採集患兒凝血酶原時間、血氨、穀丙轉氨酶、穀草轉氨酶、血氨總膽紅素、直接膽紅素等指標,併對35例存在肝性腦病患兒治療前後進行Glasgow昏迷評分.結果 39例患幾經PE+ CVVHDF治療後20例ALF患兒(51.3%)肝功能恢複正常齣院,7例治療過程中死亡,12例因箇人原因治療過程中放棄治療,後電話隨訪死亡.經PE+ CVVHDF治療後,患兒總膽紅素、直接膽紅素、穀丙轉氨酶、穀草轉氨酶分彆較治療前下降[(128.8 ±82.6) μmol/L vs (73.2±92.4) μmol/L;(90.2±71.5)μmol/L vs (55.1±42.6)μmol/L;(3 024.1±2457.0)U/L vs(1 256.8 ±757.8)U/L;(3 420.6±2216.3)U/L vs (579.4±338.6)U/L] (P <0.05);治療後凝血酶原時間較治療前縮短[(40.4±23.0)s vs(22.8±9.4)s](P<0.0l),臨床齣血傾嚮明顯減輕;Glasgow昏迷評分明顯升高[(9.5±3.1)分vs (12.1±2.9)分](P<0.01).結論 PE聯閤CVVHDF治療小兒ALF可明顯改善臨床癥狀及生化指標,安全性好,無明顯不良反應.
목적 탐토혈장치환(plasma exchange,PE)연합지속정정맥혈액투석려과(continuous veno-venous hemodialysis filtration,CVVHDF)치료인동급성간공능쇠갈(acute liver failure,ALE)적응용개치.방법 중국의과대학부속성경의원PICU 2008년8월지2014년1월수치39례부합ALF진단환인,행PE연합CVVHDF치료,치료방법위PE후립즉진행CVVHDF,매차PE+ CVVHDF력시24~72h,치료전후채집환인응혈매원시간、혈안、곡병전안매、곡초전안매、혈안총담홍소、직접담홍소등지표,병대35례존재간성뇌병환인치료전후진행Glasgow혼미평분.결과 39례환궤경PE+ CVVHDF치료후20례ALF환인(51.3%)간공능회복정상출원,7례치료과정중사망,12례인개인원인치료과정중방기치료,후전화수방사망.경PE+ CVVHDF치료후,환인총담홍소、직접담홍소、곡병전안매、곡초전안매분별교치료전하강[(128.8 ±82.6) μmol/L vs (73.2±92.4) μmol/L;(90.2±71.5)μmol/L vs (55.1±42.6)μmol/L;(3 024.1±2457.0)U/L vs(1 256.8 ±757.8)U/L;(3 420.6±2216.3)U/L vs (579.4±338.6)U/L] (P <0.05);치료후응혈매원시간교치료전축단[(40.4±23.0)s vs(22.8±9.4)s](P<0.0l),림상출혈경향명현감경;Glasgow혼미평분명현승고[(9.5±3.1)분vs (12.1±2.9)분](P<0.01).결론 PE연합CVVHDF치료소인ALF가명현개선림상증상급생화지표,안전성호,무명현불량반응.
Objective To observe the clinical effect of plasma exchange(PE) combined with continuous veno-venous hemodialysis filtration(CVVHDF) in children with acute liver failure.Methods Thirty-nine cases with acute liver failure admitted to pediatric intensive care unit of Shengjing Hospital Affiliated to China Medical University from August 2008 to January 2014 were treated with PE combined with CVVHDF.CVVHDF was performed after PE immediately,each PE + CVVHDF lasted 24 ~ 72 hours.Prothrombin time,blood ammonia,alanine transaminase,aspartate transaminase,serum total bilirubin,conjugated bilirubin were detected before and after PE + CVVHDF treatment.Glasgow Coma Scale were assessed before and after PE +CVVHDF in the thirty-five cases with hepatic encephalopathy.Results After the treatment of PE + CVVHDF,20 children were clinical recover,7 died,12 abandoned the treatment and the results of follow-up were death.PE + CVVHDF was effective in the treatment by decreasing serum total bilirubin,conjugated bilirubin,alanine transaminase,aspartate transaminase [(128.8 ± 82.6) μmol/L vs (73.2 ± 92.4) μmol/L; (90.2 ±71.5) μmol/L vs (55.1 ± 42.6) μmol/L; (3 024.1 ± 2 457.0) U/L vs (1 256.8 ± 757.8) U/L; (3 420.6 ±2 216.3) U/L v s (579.4 ± 338.6) U/L] (P < 0.05),increasing Glasgow Coma Scale (9.5 ± 3.1 vs 12.1 ±2.9) (P <0.01),shortening prothrombin time[(40.4 ± 23.0) s vs (22.8 ±9.4) s] (P <0.01),in association with the improvement of hemorrhage tendency.Conclusion PE + CVVHDF significantly improves clinical symptoms and biochemical abnormalities in children with acute liver failure.Security of PE + CVVHDF is good and with no obvious adverse reactions.