中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
Chinese Journal of Perinatal Medicine
2015年
10期
737-741
,共5页
蔡成%龚小慧%裘刚%颜崇兵%宋之君%陈一欢
蔡成%龔小慧%裘剛%顏崇兵%宋之君%陳一歡
채성%공소혜%구강%안숭병%송지군%진일환
危重病%血液滤过%婴儿,新生%有效性研究
危重病%血液濾過%嬰兒,新生%有效性研究
위중병%혈액려과%영인,신생%유효성연구
Critical illness%Hemofiltration%Infant,newborn%Validation studies
目的 探讨连续性血液净化(continuous blood purification,CBP)在救治危重症新生儿中的可行性及有效性. 方法 2011年6月至201 5年5月,上海市儿童医院新生儿重症监护病房使用CBP技术救治10例危重症新生儿.CBP治疗指征为多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)常规治疗效果不明显、伴有急性肾功能衰竭.CBP模式采用连续性静脉-静脉血液滤过透析.观察治疗前、治疗6、12、24和48 h及治疗结束时的血电解质及生化指标、尿量、血流动力学指标及肾上腺素静脉维持剂量,以及CBP相关的并发症.采用方差分析和Dunnett-t检验进行统计学分析. 结果 10例危重症新生儿的原发疾病分别为败血症5例、出生时重度窒息2例、先天性遗传代谢病2例、创伤性窒息l例.10例患儿静脉置管均顺利,平均转流时间为(86.7±25.9)h,疗效评估均显示有效.其中4例患儿治愈出院;其余6例虽然均度过急性肾功能衰竭的少尿期,但因神经系统损伤无法恢复,放弃治疗后死亡.10例患儿CBP并发症情况:血小板减少3例、管路堵塞2例、低血压l例,未发生低体温、血栓形成、出血、感染.治疗6h时,10例患儿的平均血压和动脉血氧分压/吸入氧分数值的比值均上升[分别为[(46.4±7.5)和(210.0±62.0)mmHg,1 mmHg=0.133 kPa],与治疗前[分别为(36.5±8.3)和(93.0±43.0) mmHg]比较,差异有统计学意义(t值分别2.647和6.378,P值均＜0.05).治疗12h时血pH(7.4±0.2)高于治疗前(6.9±0.2)(t=2.731,P＜0.05),且上升维持在正常范围.治疗24 h时,血K+、尿素氮、肌酐分别为(4.8±2.9) mmol/L、(7.2±2.3)mmol/L、(51.0±12.0)μmol/L,均降低到正常范围,与治疗前[(9.6±3.6)mmol/L、(13.6±6.3)mmol/L、(172.0±23.0)μmol/L]比较,差异均有统计学意义(t值分别为4.571、5.427和21.672,P值均＜0.05);尿量从治疗前(0.0±0.0) ml/ (kg·h)升高至(0.7±0.3) ml/ (kg·h)(t=3.284,P＜0.05).治疗12h时,肾上腺素静脉维持量即明显下调,48 h时停用. 结论 CBP技术用于危重症新生儿的救治,是一种有效可行的措施.
目的 探討連續性血液淨化(continuous blood purification,CBP)在救治危重癥新生兒中的可行性及有效性. 方法 2011年6月至201 5年5月,上海市兒童醫院新生兒重癥鑑護病房使用CBP技術救治10例危重癥新生兒.CBP治療指徵為多器官功能障礙綜閤徵(multiple organ dysfunction syndrome,MODS)常規治療效果不明顯、伴有急性腎功能衰竭.CBP模式採用連續性靜脈-靜脈血液濾過透析.觀察治療前、治療6、12、24和48 h及治療結束時的血電解質及生化指標、尿量、血流動力學指標及腎上腺素靜脈維持劑量,以及CBP相關的併髮癥.採用方差分析和Dunnett-t檢驗進行統計學分析. 結果 10例危重癥新生兒的原髮疾病分彆為敗血癥5例、齣生時重度窒息2例、先天性遺傳代謝病2例、創傷性窒息l例.10例患兒靜脈置管均順利,平均轉流時間為(86.7±25.9)h,療效評估均顯示有效.其中4例患兒治愈齣院;其餘6例雖然均度過急性腎功能衰竭的少尿期,但因神經繫統損傷無法恢複,放棄治療後死亡.10例患兒CBP併髮癥情況:血小闆減少3例、管路堵塞2例、低血壓l例,未髮生低體溫、血栓形成、齣血、感染.治療6h時,10例患兒的平均血壓和動脈血氧分壓/吸入氧分數值的比值均上升[分彆為[(46.4±7.5)和(210.0±62.0)mmHg,1 mmHg=0.133 kPa],與治療前[分彆為(36.5±8.3)和(93.0±43.0) mmHg]比較,差異有統計學意義(t值分彆2.647和6.378,P值均＜0.05).治療12h時血pH(7.4±0.2)高于治療前(6.9±0.2)(t=2.731,P＜0.05),且上升維持在正常範圍.治療24 h時,血K+、尿素氮、肌酐分彆為(4.8±2.9) mmol/L、(7.2±2.3)mmol/L、(51.0±12.0)μmol/L,均降低到正常範圍,與治療前[(9.6±3.6)mmol/L、(13.6±6.3)mmol/L、(172.0±23.0)μmol/L]比較,差異均有統計學意義(t值分彆為4.571、5.427和21.672,P值均＜0.05);尿量從治療前(0.0±0.0) ml/ (kg·h)升高至(0.7±0.3) ml/ (kg·h)(t=3.284,P＜0.05).治療12h時,腎上腺素靜脈維持量即明顯下調,48 h時停用. 結論 CBP技術用于危重癥新生兒的救治,是一種有效可行的措施.
목적 탐토련속성혈액정화(continuous blood purification,CBP)재구치위중증신생인중적가행성급유효성. 방법 2011년6월지201 5년5월,상해시인동의원신생인중증감호병방사용CBP기술구치10례위중증신생인.CBP치료지정위다기관공능장애종합정(multiple organ dysfunction syndrome,MODS)상규치료효과불명현、반유급성신공능쇠갈.CBP모식채용련속성정맥-정맥혈액려과투석.관찰치료전、치료6、12、24화48 h급치료결속시적혈전해질급생화지표、뇨량、혈류동역학지표급신상선소정맥유지제량,이급CBP상관적병발증.채용방차분석화Dunnett-t검험진행통계학분석. 결과 10례위중증신생인적원발질병분별위패혈증5례、출생시중도질식2례、선천성유전대사병2례、창상성질식l례.10례환인정맥치관균순리,평균전류시간위(86.7±25.9)h,료효평고균현시유효.기중4례환인치유출원;기여6례수연균도과급성신공능쇠갈적소뇨기,단인신경계통손상무법회복,방기치료후사망.10례환인CBP병발증정황:혈소판감소3례、관로도새2례、저혈압l례,미발생저체온、혈전형성、출혈、감염.치료6h시,10례환인적평균혈압화동맥혈양분압/흡입양분수치적비치균상승[분별위[(46.4±7.5)화(210.0±62.0)mmHg,1 mmHg=0.133 kPa],여치료전[분별위(36.5±8.3)화(93.0±43.0) mmHg]비교,차이유통계학의의(t치분별2.647화6.378,P치균＜0.05).치료12h시혈pH(7.4±0.2)고우치료전(6.9±0.2)(t=2.731,P＜0.05),차상승유지재정상범위.치료24 h시,혈K+、뇨소담、기항분별위(4.8±2.9) mmol/L、(7.2±2.3)mmol/L、(51.0±12.0)μmol/L,균강저도정상범위,여치료전[(9.6±3.6)mmol/L、(13.6±6.3)mmol/L、(172.0±23.0)μmol/L]비교,차이균유통계학의의(t치분별위4.571、5.427화21.672,P치균＜0.05);뇨량종치료전(0.0±0.0) ml/ (kg·h)승고지(0.7±0.3) ml/ (kg·h)(t=3.284,P＜0.05).치료12h시,신상선소정맥유지량즉명현하조,48 h시정용. 결론 CBP기술용우위중증신생인적구치,시일충유효가행적조시.
Objective To explore the efficacy and safety of bedside continuous blood purification (CBP) in the treatment of critically ill neonates.Methods Totally ten critically ill neonates were hospitalized in Department of Neonatal Intensive Care Unit (NICU) in Shanghai Children's Hospital from June 2011 to May 2015, and managed with CBP treatment.The indications of CBP therapy were multiple organ dysfunction syndrome (MODS) failed to conventional treatment or combined with acute renal failure (ARF).The model for CBP was continuous veno-venous hemofiltration dialysis (CVVH).The clinical outcomes included blood electrolytes, serum bio markers, urine output, hemodynamic indicators, dose of intravenous epinephrine before treatment, 6, 12, 24, 48 h after treatment and at the end of CBP.Complications of CBP were also observed.Statistical analysis was performed with ANOVA and Dunnett-t test.Results The underlying problems of the ten newborns were septicemia (n=5), severe neonatal asphyxia (n=2), congenital hereditary metabolic disease (n=2) and traumatic asphyxia (n=l).The venous catheter was successfully inserted for all babies and CBP treatment continued for (86.7 ± 25.9) h averagely with obvious effect.Four of the ten cases were cured and discharged, and the rest six refused to treatment and died after due to irreversible injury of the nervous system although they had survived from the oliguric stage of ARF.The complications of CBP included thrombocytopenia (n=3), catheter blockage (n=2), hypotension (n=l).No hypothermia, thrombosis, bleeding or infection occurred.The mean blood pressure and partial pressure of oxygen in arterial blood/fraction of inspiration oxygen (PaO2/ FiO2) of the ten cases 6 h after the beginning of treatment were higher than those before [(46.4 ± 7.5) vs (36.5 ±8.3) mmHg, 1 mmHg=0.133 kPa;(210.0±62.0) vs (93.0±43.0) mmHg;t=2.647 and 6.378, both P ＜ 0.05].At the 12th hour since treatment start, the blood pH value was 7.4 ± 0.2, which was higher than that before treatment (6.9 ± 0.2, t=2.731, P ＜ 0.05), and kept in normal range.At the 24th hour, the serum levels of potassium, urea nitrogen and creatinine dropped to normal range compared to those before treatment [(4.8±2.9) vs (9.6± 3.6) mmol/L;(7.2±2.3) vs (13.6±6.3) mmol/L;(51.0± 12.0) vs (172.0±23.0) μ mol/L;t=4.571, 5.427 and 21.672, all P ＜ 0.05].Urine output increased from zero before the treatment to (0.7±0.3) ml/(kg · h) after 24 h (t=3.284, P ＜ 0.05).The maintaining dose of intravenous epinephrine decreased since 12 h after the beginning of treatment and was ceased at the 48th hour.Conclusion CBP is an effective and feasible treatment for critically ill neonates.
