【作者】 闫钢风； 陆国平； 钱素云； 王莹； 张育才； 卢秀兰；

【Author】 Yan Gang-feng;Lu Guo-ping;Qian Su-yun;Wang Ying;Zhang Yu-cai;Lu Xiu-lan;

【机构】 复旦大学附属儿科医院； 北京儿童医院； 上海儿童医学中心； 上海市儿童医院； 湖南省儿童医院；

【摘要】 目的:探讨连续血液净化(CRRT)在严重脓毒症的治疗作用和对患者预后的影响。方法:采用多中心、非随机、对照临床研究方法,共有5个中心参与。2013年3月到2014年10月中国5家专科儿童医院住院的严重脓毒症患者为研究对象。根据家长治疗意愿分成治疗组(常规治疗+CRRT治疗)和对照组(常规治疗)。比较两组患者呼吸和循环功能、血浆炎性指标、小儿危重评分和死亡风险评分、28天生存率,评价CRRT对患者治疗意义。结果:总共入选128例患者。治疗组和对照组在心率、PaO2/FiO2比值、炎症介质指标(WBC计数、CRP、PCT)、PRISM评分、小儿危重评分比较无统计学意义(p>0.05)。治疗组平均动脉压升高较对照组显著(75.34±0.87比67.97±0.83,p<0.05)。28天生存率:治疗组28天生存率为73.77%,对照组为52.24%,治疗组28天生存率高于对照组,两组比较有统计学差异(p<0.05)。治疗组在PICU住院时间少于对照组(p<0.05)。结论:CRRT在治疗儿童严重脓毒症时,未能显著改善严重脓毒症患者的血浆炎性指标,但可以促进血流动力学稳定、改善患者预后。更多还原

【Abstract】 Objective:There is uncertainty on the outcome of continuous renal replacement therapy(CRRT) for the treatment of patients with severe sepsis in Pediatric Intensive Care Unit(PICU).This clinical trial is to observe the effect of CRRT on pediatric patients with severe sepsis.Methods:A prospective nonrandomized multicenter trial comparing two treatments in patients suffering from severe sepsis admitted to PICU,treated by CRRT or without CRRT.128 severe sepsis patients were assigned nonrandomly to the treatment group and control group.28-day survival rate,length of ICU and hospital,respiratory function,heat function,plasma inflammation factors were observed.Results:The changes in the account of WBC and CRP and PCT,PRISM score and heart rate were no statistically significant difference(p > 0.05).Mean artery pressure of treatment group was higher than control group(75.34 ± 0.87 vs.67.97 ± 0.83,p < 0.05).28-day survival rate in treatment group was higher than control group(73.77%vs.52.24%,p < 0.05).The length of ICU in treatment group was shorter than control group(p < 0.05).But there were no statistically significant difference in length of hospital between two groups(p > 0.05).Conclusions:These data suggest that there is no evidence to suggest that CRRT may shorten the time of length of stay in hospital of the pediatric patients with severe sepsis,but it may be reduce the length of stay in PICU and be in favor of improving stability of hemodynamics and the prognosis.更多还原