摘要
目的:观察连续血液净化(CBP)治疗儿童感染性休克的疗效及其免疫机制。方法:选择广东省深圳市儿童医院2002年6月—2005年10月用连续性静静脉血液滤过(CVVH)治疗的12例感染性休克患儿作为CBP治疗组;同期选择本院另20例住院感染性休克患儿作为对照组。动态观察患儿CVVH治疗前及治疗后24h和48 h血pH、氧合指数、HCO3-、剩余碱(BE)、血尿素氮(BUN)、血肌酐(SC r)、血压、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)的变化;同时观察血浆肿瘤坏死因子α(TNFα)、白细胞介素1(IL 1)、IL 6、IL8等前炎症因子和血小板活化因子水平。结果:8例救治成功,4例死亡,病死率33.3%。CBP治疗组治疗后APACHEⅡ评分较治疗前明显降低(P<0.05),其他生化指标与治疗前比较差异有显著性(P<0.05或P<0.01);CBP治疗组治疗后TNFα、IL 1、IL 8血浆水平均明显降低(P<0.05或P<0.01);对照组变化不明显。结论:对感染性休克患儿及早进行CBP,可避免发生不可逆性脏器功能损害,可提高救治成功率。
Objective： To observe the effects and immunological mechanism of continuous blood purification （CBP） in treatment of children with infectious shock. Methods： Twelve children with infectious shock treated with continuous veno-venus hemofiltration （CVVH） in intensive care unit （ICU） from June 2002 to October 2005 were selected as CBP treatment group, and 20 children with infectious shock without the treatment were selected as controls at the same time. The levels of pH, oxygenation index, HCO3, base excess （BE）, blood urea nitrogen （BUN）, serum creatinine （SCr）, blood pressure and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） were examined before and 24, 48 hours after treatment dynamically, while the levels of tumor necrosis factor-α （TNF-α）, interleukin -1 （IL-1）, IL-6 and IL-8 were detected and analyzed by SPSS 10.0 software. Results： Among the 12 patients, 8 cases survived, 4 cases died and the mortality rate was 33.3%. In CBP treatment group, APACHE Ⅱ decreased after treatment, and other biochemical parameters were all improved, plasma concentrations of TNF-α, IL -1 and IL-8 decreased （P〈0.05 or P〈0.01）. But the changes in above-mentioned parameters were not significant in control group. Conclusion： CBP plays an important role in treatment of infectious shock, and early treatment with CBP may offer the opportunity to reduce mortality and avoid the multiple organ dysfunction syndrome.
出处
《中国中西医结合急救杂志》
CAS
2006年第3期168-171,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
广东省深圳市医学科研项目(200204186)
关键词
休克
感染性
连续性血液净化
炎症因子
infectious shock
continuous blood purification
inflammation factor
