CAJ | 학술논문

目的对儿童严重脓毒症进行连续血液净化(CBP)治疗后,观察各脏器功能的改善、炎症介质的变化及预后等情况,评价CBP在儿童严重脓毒症救治中的疗效.方法以2011年10月1日至2012年9月30日入住上海、浙江5家医院PICU年龄为29 d～16岁47例严重脓毒症患儿为研究对象.接受CBP治疗的30例记为登录组,未接受CBP治疗的17例记为未登录组.观察两组在入组时(d0)、第1天(d1)、第2天(d2)、第3天(d3)、第5天(d5)的心血管功能、呼吸功能、肾功能及炎症指标变化,并进行儿童死亡风险(PRISM)评分Ⅲ、儿童危重病例评分(PCIS)及生存分析.结果 (1)心血管功能:在d3及d5,登录组与未登录组比较心率(HR)[(121、119次/min)vs.(138、137次/min)]及平均动脉压(MAP)[(71、80 mmHg)vs.(63、62 mmHg)(1 mmHg =0.133 kPa)]均有所改善(P均＜0.05).动脉血乳酸浓度差异无统计学意义.(2)呼吸功能:氧合指数(PaO2/FiO2)、动脉血氧饱和度(SaO2)登陆组较未登录组有所上升,但差异无统计学意义.(3)肾功能:血尿素氮(BUN)及血肌酐(Cr)登陆组逐渐下降,未登录组无明显下降;在d1、d2、d3、d5登录组与未登录组比较BUN[(5.5、3.6、3.4、3.0 mmol/L)vs.(8.5、9.1、7.9、6.6 mmo]/L)]及Cr[(24.0、16.5、13.5、9.5μmol/L)vs.(35.0、39.2、41.2、33.0 μmol/L)]均有所改善(P均＜0.05).(4)炎症介质指标:总白细胞计数(TWCC)、C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)两组内及两组间差异均无统计学意义.(5)预后:虽然PCIS登录组有改善趋势,但PRISM评分Ⅲ、PCIS两组间差异无统计学意义.28 d生存率,登录组为70.0％,未登录组为52.9％,但组间差异无统计学意义(P =0.242).结论 CBP可以改善严重脓毒症患儿循环功能、氧合功能、明显改善肾功能;未发现CBP可以明显降低炎症介质水平、改善危重评分及28 d生存率.
목적 대인동엄중농독증진행련속혈액정화(CBP)치료후,관찰각장기공능적개선、염증개질적변화급예후등정황,평개CBP재인동엄중농독증구치중적료효.방법 이2011년10월1일지2012년9월30일입주상해、절강5가의원PICU년령위29 d～16세47례엄중농독증환인위연구대상.접수CBP치료적30례기위등록조,미접수CBP치료적17례기위미등록조.관찰량조재입조시(d0)、제1천(d1)、제2천(d2)、제3천(d3)、제5천(d5)적심혈관공능、호흡공능、신공능급염증지표변화,병진행인동사망풍험(PRISM)평분Ⅲ、인동위중병례평분(PCIS)급생존분석.결과 (1)심혈관공능:재d3급d5,등록조여미등록조비교심솔(HR)[(121、119차/min)vs.(138、137차/min)]급평균동맥압(MAP)[(71、80 mmHg)vs.(63、62 mmHg)(1 mmHg =0.133 kPa)]균유소개선(P균＜0.05).동맥혈유산농도차이무통계학의의.(2)호흡공능:양합지수(PaO2/FiO2)、동맥혈양포화도(SaO2)등륙조교미등록조유소상승,단차이무통계학의의.(3)신공능:혈뇨소담(BUN)급혈기항(Cr)등륙조축점하강,미등록조무명현하강;재d1、d2、d3、d5등록조여미등록조비교BUN[(5.5、3.6、3.4、3.0 mmol/L)vs.(8.5、9.1、7.9、6.6 mmo]/L)]급Cr[(24.0、16.5、13.5、9.5μmol/L)vs.(35.0、39.2、41.2、33.0 μmol/L)]균유소개선(P균＜0.05).(4)염증개질지표:총백세포계수(TWCC)、C반응단백(CRP)、백세포개소-6(IL-6)、백세포개소-10(IL-10)、종류배사인자-α(TNF-α)량조내급량조간차이균무통계학의의.(5)예후:수연PCIS등록조유개선추세,단PRISM평분Ⅲ、PCIS량조간차이무통계학의의.28 d생존솔,등록조위70.0％,미등록조위52.9％,단조간차이무통계학의의(P =0.242).결론 CBP가이개선엄중농독증환인순배공능、양합공능、명현개선신공능;미발현CBP가이명현강저염증개질수평、개선위중평분급28 d생존솔.
Objective To evaluate efficacy of continuous blood purification (CBP) in childhood severe sepsis through the analysis of organ function,inflammatory mediators and prognosis.Method Forty-seven children with severe sepsis aged 29 days-16 years who were treated in PICU of Shanghai and Zhejiang five hospitals during October 1,2011 and September 30,2012 wcrc cnrolled; 30 cases treated with CBP were recorded as logged group,17 cases without CBP as unlogged group.Changes in the cardiovascular,respiratory function,renal function,inflammatory markers,PRISM score Ⅲ,PCIS and survival were observed and compared between the two groups at baseline (d0),first days (d1),second days (d2),third days (d3),fifth days (d5).Result (1) Cardiovascular function:In d3 and d5,heart rate (HR) and mean arterial pressure (MAP) were improved as compared to unlogged group (121,119 vs.138,137; 71,80 mmHg vs.63,62 mmHg,P ＜ 0.05),with no statistical significance in arterial blood lactate concentration.(2) Oxygenation index (PaO2/FiO2) and arterial oxygen saturation (SaO2) incrcascd as compared to unlogged group,but did not reach statistical significance.(3) Blood urea nitrogen (BUN)and creatinine (Cr) were improved as compared with unlogged group from d1 (P ＜ 0.05).(4)Inflammatory mediators did not show significant differences.(5) Twenty-eight days survival rate:logged group was 70.0％,unlogged group was 52.9％,but the difference was not statistically significant (P =0.242).Conclusion CBP can improve circulatory function,oxygenation,and renal function in children with severe sepsis.No evidence was found that CBP could decrease the level of inflammatory mediators,improve critical score and 28 days survival rate.