中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2015年
1期
5-8
,共4页
龚小慧%颜崇兵%裘刚%孙婧婧%蔡成
龔小慧%顏崇兵%裘剛%孫婧婧%蔡成
공소혜%안숭병%구강%손청청%채성
连续性血液净化%多脏器衰竭%危重症%新生儿
連續性血液淨化%多髒器衰竭%危重癥%新生兒
련속성혈액정화%다장기쇠갈%위중증%신생인
Continuous blood purification%Multiple organ failure%Critically ill%Neonates
目的 探讨床旁连续性血液净化(continuous blood purification,CBP)技术在救治新生儿多脏器功能衰竭(multiple organ failure,MOF)中的疗效及安全性.方法 2011年6月至2013年6月在我院NICU住院并接受CBP治疗的6例MOF新生儿(均存在急性肾功能衰竭),分析该6例新生儿的一般临床资料,在常规治疗基础上进行CBP治疗,CBP模式为连续性静-静脉血液滤过透析(continuous vein-vein hemodialysis filtration,CVVHDF),血流速率3～5 ml/(kg·min),置换液剂量20 ～ 30 ml/(kg·h),透析液剂量为15～25 ml/(min·m2).观察CVVHDF治疗前及治疗6h、12h、24h、48 h、结束时MOF新生儿的血压,血pH、K+、Na+、血尿素氮、血肌酐、尿量、氧合指数(PaO2/FiO2)以及肾上腺素静脉维持剂量等指标变化,评价CBP在新生儿MOF救治中的效果.结果 6例MOF新生儿胎龄33 ～41周,入院日龄2～19d,出生体重2.25～ 3.36 kg;原发疾病脓毒症4例(其中1例合并先天性遗传代谢病),重度窒息2例;6例患儿均静脉置管顺利,转流时间49 ～ 106 h.与CVVHDF治疗前比较,血K+、血尿素氮、血肌酐治疗12h明显下降[(5.32±1.84) mmol/L vs.(9.81±3.61) mmol/L,(9.0±3.4) mmol/L vs.(12.8±6.1)mmol/L,(99±16) μmoVL vs.(176 ±25) μmol/L,P＜0.05],24 h达到正常范围,尿量治疗24 h开始增多,PaO2/FiO2治疗6h达200 mmHg(1mmHg =0.133 kPa),24 h ＞300 mmHg(P ＜0.05);肾上腺素静脉维持量治疗12h可下调50％,48 h可停用.6例患儿CBP治疗均显示有效.结论 床旁CBP技术在新生儿MOF救治中应用安全,可有效帮助患儿度过MOF的肾功能衰竭阶段.
目的 探討床徬連續性血液淨化(continuous blood purification,CBP)技術在救治新生兒多髒器功能衰竭(multiple organ failure,MOF)中的療效及安全性.方法 2011年6月至2013年6月在我院NICU住院併接受CBP治療的6例MOF新生兒(均存在急性腎功能衰竭),分析該6例新生兒的一般臨床資料,在常規治療基礎上進行CBP治療,CBP模式為連續性靜-靜脈血液濾過透析(continuous vein-vein hemodialysis filtration,CVVHDF),血流速率3～5 ml/(kg·min),置換液劑量20 ～ 30 ml/(kg·h),透析液劑量為15～25 ml/(min·m2).觀察CVVHDF治療前及治療6h、12h、24h、48 h、結束時MOF新生兒的血壓,血pH、K+、Na+、血尿素氮、血肌酐、尿量、氧閤指數(PaO2/FiO2)以及腎上腺素靜脈維持劑量等指標變化,評價CBP在新生兒MOF救治中的效果.結果 6例MOF新生兒胎齡33 ～41週,入院日齡2～19d,齣生體重2.25～ 3.36 kg;原髮疾病膿毒癥4例(其中1例閤併先天性遺傳代謝病),重度窒息2例;6例患兒均靜脈置管順利,轉流時間49 ～ 106 h.與CVVHDF治療前比較,血K+、血尿素氮、血肌酐治療12h明顯下降[(5.32±1.84) mmol/L vs.(9.81±3.61) mmol/L,(9.0±3.4) mmol/L vs.(12.8±6.1)mmol/L,(99±16) μmoVL vs.(176 ±25) μmol/L,P＜0.05],24 h達到正常範圍,尿量治療24 h開始增多,PaO2/FiO2治療6h達200 mmHg(1mmHg =0.133 kPa),24 h ＞300 mmHg(P ＜0.05);腎上腺素靜脈維持量治療12h可下調50％,48 h可停用.6例患兒CBP治療均顯示有效.結論 床徬CBP技術在新生兒MOF救治中應用安全,可有效幫助患兒度過MOF的腎功能衰竭階段.
목적 탐토상방련속성혈액정화(continuous blood purification,CBP)기술재구치신생인다장기공능쇠갈(multiple organ failure,MOF)중적료효급안전성.방법 2011년6월지2013년6월재아원NICU주원병접수CBP치료적6례MOF신생인(균존재급성신공능쇠갈),분석해6례신생인적일반림상자료,재상규치료기출상진행CBP치료,CBP모식위련속성정-정맥혈액려과투석(continuous vein-vein hemodialysis filtration,CVVHDF),혈류속솔3～5 ml/(kg·min),치환액제량20 ～ 30 ml/(kg·h),투석액제량위15～25 ml/(min·m2).관찰CVVHDF치료전급치료6h、12h、24h、48 h、결속시MOF신생인적혈압,혈pH、K+、Na+、혈뇨소담、혈기항、뇨량、양합지수(PaO2/FiO2)이급신상선소정맥유지제량등지표변화,평개CBP재신생인MOF구치중적효과.결과 6례MOF신생인태령33 ～41주,입원일령2～19d,출생체중2.25～ 3.36 kg;원발질병농독증4례(기중1례합병선천성유전대사병),중도질식2례;6례환인균정맥치관순리,전류시간49 ～ 106 h.여CVVHDF치료전비교,혈K+、혈뇨소담、혈기항치료12h명현하강[(5.32±1.84) mmol/L vs.(9.81±3.61) mmol/L,(9.0±3.4) mmol/L vs.(12.8±6.1)mmol/L,(99±16) μmoVL vs.(176 ±25) μmol/L,P＜0.05],24 h체도정상범위,뇨량치료24 h개시증다,PaO2/FiO2치료6h체200 mmHg(1mmHg =0.133 kPa),24 h ＞300 mmHg(P ＜0.05);신상선소정맥유지량치료12h가하조50％,48 h가정용.6례환인CBP치료균현시유효.결론 상방CBP기술재신생인MOF구치중응용안전,가유효방조환인도과MOF적신공능쇠갈계단.
Objective To explore the efficacy and safety of bedside continuous blood purification (CBP) in the treatment of neonatal multiple organ failure (MOF).Methods Totally 6 newborn infants of MOF were hospitalized in department of neonatology in our hospital from June 2011 to June 2013.These 6 cases of clinical data were retrospectively analyzed,6 neonates were treated with CBP combined with conventional treatment.The model for CBP was continuous veno-venous hemodialysis filtration (CVVHDF),blood flow velocity was 3 to 5 ml/(kg· min),replacement fluid dose was 20 to 30 ml/(kg· h),dialysis fluid dose was 15 to 25 rnl/(min· m2).The clinical outcome measures included,blood pressure,blood pH,K+,Na+,blood urea nitrogen,creatinine,urine volume,PaO2/FiO2 and epinephrine intravenous dose,respectively before CBP treatment,6 h,12 h,24 h,48 h after CBP treatment and the end of CBP treatment.The efficacy of CBP treatment was evaluated in neonatal MOF.Results Gestational age of 6 neonates with MOF was 33 to 41 weeks,2 to 19 days old,2.25 to 3.36 kg birth weight.Primary disease was 4 cases of neonatal septicemia(1 case with congenital hereditary metabolic disease),2 cases of severe neonatal asphyxia.All 6 cases of venous catheter were smoothly done.CBP treatment persisted for 49 to 106 hours.Compared with before CVVHDF treatment,blood K+,blood urea nitrogen,creatinine significantly decreased at 12 h after CVVHDF treatment [(5.32 ± 1.84) mmol/L vs.(9.81 ±3.61) mmol/L,(9.0 ±3.4) mmol/L vs.(12.8 ±6.1) mmol/L,(99 ± 16) μmol/L vs.(176 ±25) μmol/L,P ＜0.05],and reached the normal range at 24 h after treatment,urine volume significantly increased at 24 h after treatment (P ＜ 0.05).PaO2/FiO2 reached 200 mmHg (1 mmHg =0.133 kPa) at 6 h after treatment and more than 300 mmHg at 24 h after treatment(P ＜0.05).Fifty percent of epinephrine intravenous dose were down-regulation at 12 h after treatment and stopped using epinephrine at 48 h after treatment.CBP treatment of 6 cases showed effective.Conclusion Application of bedside CBP treatment in neonatal MOF is safe,can effectively help neonates with MOF to skip over renal failure stage.
