摘要
目的探讨床旁血浆置换（plasma exchange，PE）联合连续性静一静脉血液滤过透析（continuous veno-venous hemodiafiltration，CVVHDF）在抢救儿童重症溶血尿毒综合征（hemolytic uremic syndrome，HUS）中的作用。方法总结本院PICU收治的HUS患儿的临床特点，采用儿童危重病例评分和儿童死亡危险评分Ⅲ评估病情的危重程度。对4例重症HUS患儿采用床旁PE联合CVVHDF治疗，观察病情演变与转归情况。结果2012年6月至2015年5月我院PICU收治重症HUS8例，经利尿剂、输血等保守治疗12～24h后，病情加重的4例危重患儿进行PE＋CVVHDF序贯式血液净化治疗。PE采用Prisma TPE 2000膜式血浆分离器，CVVHDF应用AN69M60滤器，PE每次新鲜冰冻血浆50～70ml／kg，连续3～6次，CWHDF置换液50ml／（kg-h）。4例重症患儿治疗后均存活，血生化指标和。肾功能指标改善。治疗前后血肌酐平均值（318μmol／LVS．162μmol／L）、乳酸脱氢酶（1963U／Lvs．407u／L）明显下降，血小板计数明显升高（40×10^9／LVS．97×10^9／L）。结论PE和CVVHDF治疗重症HUS，可以迅速改善患儿血生化指标，稳定内环境，阻断溶血和改善肾功能，可作为重症HUS抢救的重要手段。
Objective To investigate the efficacy of bedside plasma exchange（PE） combined continuous veno-venous hemodiafiltration （CVVHDF） in children with critical hemolytic uremic syndrome （HUS）. Methods Eight patients with HUS from Pediatric Intensive Care Unit of Shanghai Children＇s Hospitai were included in the present study. The severity of children was graded according to pediatric critical illness score and pediatric risk of score mortality Ⅲ. Four of them received continuous blood purification treatment. Meanwhile, the clinical manifestation and outcome of HUS were analyzed. Results Eight children with HUS were initially treated with diuretic and blood transfusion for 12-24 hours. Four cases who deteriorated aggressively were performed PE and CVVHDF. Plasauto iQ21 and Prisma flex were used with Prisma TPE 2000 membrane plasma separator and AN69 M60 membrane filter respectively. All the 4 patients with critical HUS survived after bedside continuous blood purification treatment. Clinical symptoms and serum biochemistry were improved significantly as follows. The average levels of serum creatinine and lactate dehydrogenase decreased obviously（318 μmol/L vs. 162 μmol/L; 1 963 U/L vs. 407 U/L,respectively）. In addi- tion,platelet count increased significantly（40 × 10^9/L vs. 97 × 10^9/L）. Eventually, symptoms disappeared in these 4 patients. Conclusion The combined therapy of PE and CVVHDF in HUS could stabilize fluid acidbase equilibrium, prevent hemolysis and improve the renal function.
出处
《中国小儿急救医学》
CAS
2016年第8期531-534,共4页
Chinese Pediatric Emergency Medicine
基金
上海市申康医院发展中心新兴前沿技术项目（SHDC12014116）
上海市科委科技攻关项目（12411952404）
