摘要
目的比较采用两种不同剂量置换液对ARDS患儿进行连续性血液净化（continuousbloodpurification，CBP）的临床疗效。方法选取我院2016年8月至2017年5月收治的ARDS患儿42例，均采用肺保护性机械通气策略等基础疗法，并在此基础上进行CBP治疗，按入院时间顺序编号、采用随机数字表法分为两组：高剂量组21例，采用高剂量置换液（50～70ml·k^-1·h^-1）治疗；常规剂量组21例，采用常规剂量置换液（20～35ml·k^-1·h^-1）治疗。记录并比较两组患儿治疗前、治疗1d、3d时的吸入氧浓度（FiOz）、呼气末正压（PEEP）、呼吸频率（R）、氧合指数（PaOz／FiO：）、PaCO2、PaO。等呼吸系统指标，比较两组患儿CBP治疗时间、入住PIcu时间、机械通气时间，评价两组患儿治疗6d时第3代小儿死亡风险（PRIsMⅢ）评分、小儿危重病例评分（PCIS），并记录CBP治疗效果及不良事件发生率。结果治疗1d、3d，两组患儿FiO2、PEEP、P、PaO2／FiO2、PaCO2、PaO2均较治疗前改善，且治疗3d时血气指标改善更明显，各组间比较均差异有统计学意义（P〈0．05）；治疗1d、3d，高剂量组FiO2、PEEP均较低剂量组同时期低，PaO2／FiO2较常规剂量组同时期高（P〈0．05）。高剂量组机械通气时间显著低于常规剂量组，治疗6d时PCIS明显低于常规剂量组（P〈0．05）。两组患儿各并发症发生率及总并发症发生率差异无统计学意义（P〉0．05）。结论采用高剂量置换液进行CBP治疗ARDS患儿可显著改善氧合状态，但对其他指标无明显优势，应根据患儿临床情况进行选择。
Objective To compare the clinical efficacy of children with acute respiratory distress syndrome （ARDS） treated with continuous blood purification （CBP） in two different doses. Methods A number of 42 children with ARDS in our hospital from August 2016 to May 2017, which were treated with lung protective mechanical ventilation strategy and CBP on the basis, were ordered by hospital admission sequence and were divided into two groups according to random number table：the high dose group （ n = 21） with high dose replacement fluid （50~70 ml·k^-1·h^-1）, and the conventional dose group （ n = 21） with conventional dose replacement fluid （20 ~ 35 ml·k^-1·h^-1 ）. The respiratory system indicators of FlOe, positive end expiratory pressure （PEEP）, respiratory rate （R）, PaO2/FiO2, PaCO2, PaO2 in pre-therapy, 1 d and 3 d after first therapy of the two groups were collected and compared. Duration of CBP treatment, PICU hospitalization and mechanical ventilation were compared. PRISM Ⅲ score and PCIS in 6 d after first therapy were evaluated. Treatment effect and incidences of adverse events were compared. Results On 1 d and 3 d after first therapy, FiO2 .PEEP.P. PaO2/FiO2. PaCO2 .PaO2 in the two groups were significantly improved than these in pre-therapy （ P d0.05）, and itrs better in 3 d after first therapy. On 1 d and 3 d after first therapy, FiO2 .PEEP of the high dose group were lower thanthese of the conventional group, and PaO2/FiO2 was higher than that of the conventional group （ P〈 0.05）. Duration of mechanical ventilation and PCIS in 6 d after first therapy of the high dose group were lower than these of the conventional group （ P 〈 0.05）. There were no significant differences in each complication incidences and total complication incidence between two groups （ P 〈0.05）. Conclusions CBP treatment with high dose replacement fluid can significantly improve oxygenation state of children with ARDS. However, there are no evident advantages on the other indicators. So, the dose of replacement fluid should be chosen by the clinical situation of children.
作者
胡玲
黎小年
Hu Ling Li Xiaonian(Department of Pediatrics, Hainan Maternal and Child Health Care Hospital, Haikou, 570100, China)
出处
《国际呼吸杂志》
2017年第20期1549-1553,共5页
International Journal of Respiration
基金
海南省卫生厅科学研究课题（琼卫2015PT-38）
关键词
呼吸窘迫综合征
急性
不同剂量置换液
连续性血液净化
临床疗效
Acute respiratory distress syndrome
different doses of replacement fluid
continuousblood purification
clinical efficacy
