连续性血液滤过对危重型手足口病儿童炎症介质及血流动力学的影响

曹利静, 耿文锦, 徐梅先, 霍习敏, 王晓冬, 石晓娜

中国当代儿科杂志 ›› 2016, Vol. 18 ›› Issue (3) : 219-223.

PDF(1167 KB)
HTML
PDF(1167 KB)
HTML
中国当代儿科杂志 ›› 2016, Vol. 18 ›› Issue (3) : 219-223. DOI: 10.7499/j.issn.1008-8830.2016.03.006
论著·临床研究

连续性血液滤过对危重型手足口病儿童炎症介质及血流动力学的影响

  • 曹利静, 耿文锦, 徐梅先, 霍习敏, 王晓冬, 石晓娜
作者信息 +

Effect of continuous hemofiltration on inflammatory mediators and hemodynamics in children with severe hand, foot and mouth disease

  • CAO Li-Jing, GENG Wen-Jin, XU Mei-Xian, HUO Xi-Min, WANG Xiao-Dong, SHI Xiao-Na
Author information +
文章历史 +

摘要

目的 探讨连续性静脉-静脉血液滤过(CVVH)对于危重型手足口病(HFMD)患儿炎症介质及血流动力学的影响,评估临床疗效。方法 36 例HFMD 第4 期患儿随机分为常规治疗组和CVVH 治疗组,每组18 例。CVVH 组在常规治疗基础上行CVVH 治疗。于治疗前、治疗24 h、48 h 检测外周静脉血IL-2、IL-6、IL-10、TNF-α、乳酸浓度以及心率、血压、左心室射血分数。结果 治疗24 h 后,常规治疗组血IL-2 浓度较治疗前明显降低(P<0.01),CVVH 组血IL-2、IL-6、IL-10、TNF-α 浓度均低于治疗前和常规治疗组(P<0.05)。治疗48 h 后,两组各炎症因子浓度较治疗前和治疗24 h 均明显降低(P<0.01),且CVVH 组低于常规治疗组(P<0.01)。治疗48 h 后两组患儿的心率、收缩压、血乳酸均明显降低,左心室射血分数明显增高(P<0.01);CVVH 组除收缩压以外的其他指标与常规治疗组比较,差异有统计学意义(P<0.01)。结论 CVVH 能有效清除危重型手足口病患儿体内的炎症因子,同时能降低心率、静脉血乳酸,改善心功能。

Abstract

Objective To investigate the effect of continuous veno-venous hemofiltration (CVVH) on inflammatory mediators in children with severe hand, foot and mouth disease (HFMD), and to investigate its clinical efficacy. Methods A total of 36 children with stage IV HFMD were enrolled and randomly divided into conventional treatment group and CVVH group (n=18 each). The children in the CVVH group were given CVVH for 48 hours in addition to the conventional treatment. The levels of interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) and lactic acid in peripheral venous blood, heart rate, blood pressure, and left ventricular ejection fraction were measured before treatment and after 24 and 48 hours of treatment. Results After 24 hours of treatment, the conventional treatment group had a significantly reduced serum IL-2 level (P<0.01), and the CVVH treatment group had significantly reduced serum levels of IL-2, IL-6, IL-10, and TNF-α (P<0.05). After 48 hours of treatment, both groups had significantly reduced serum levels of IL-2, IL-6, IL-10, and TNF-α (P<0.01), and the CVVH group had significantly lower levels of these inflammatory factors than the conventional treatment group (P<0.01). After 48 hours of treatment, heart rate, systolic pressure, and blood lactic acid level were significantly reduced, and left ventricular ejection fraction was significantly increased in both groups, and the CVVH group had significantly greater changes in these indices except systolic pressure than the conventional treatment group (P<0.01). Conclusions CVVH can effectively eliminate inflammatory factors, reduce heart rate and venous blood lactic acid, and improve heart function in children with severe HFMD.

关键词

手足口病 / 血液滤过 / 炎症因子 / 血流动力学 / 儿童

Key words

Hand, foot and mouth disease / Hemofiltration / Inflammatory factor / Hemodynamics / Child

引用本文

导出引用
曹利静, 耿文锦, 徐梅先, 霍习敏, 王晓冬, 石晓娜. 连续性血液滤过对危重型手足口病儿童炎症介质及血流动力学的影响[J]. 中国当代儿科杂志. 2016, 18(3): 219-223 https://doi.org/10.7499/j.issn.1008-8830.2016.03.006
CAO Li-Jing, GENG Wen-Jin, XU Mei-Xian, HUO Xi-Min, WANG Xiao-Dong, SHI Xiao-Na. Effect of continuous hemofiltration on inflammatory mediators and hemodynamics in children with severe hand, foot and mouth disease[J]. Chinese Journal of Contemporary Pediatrics. 2016, 18(3): 219-223 https://doi.org/10.7499/j.issn.1008-8830.2016.03.006

参考文献

[1] 袁海超, 陈志凤, 陈健萍, 等. 肠道病毒71 型感染重症手 足口病临床指标的应用研究[J]. 中国现代医生, 2015, 53(1): 138-140.
[2] 李维春, 武荣, 张克昌, 等. 不同病情手足口病患儿血清中 IL-1β、IL-10 和 TNF-α 水平观察[J]. 中国实验诊断学, 2011, 15(3): 524-525.
[3] 周艳, 徐元宏. 手足口病患儿血清细胞因子与免疫球蛋白水 平检测和分析[J]. 临床输血与检验, 2011, 13(1): 27-29.
[4] 卢秀兰, 吴琼, 肖政辉, 等. 连续性血液滤过治疗重症手足 口病心肺衰竭患儿的临床研究[J]. 中国小儿急救医学, 2015, 22(3): 145-155.
[5] 中华人民共和国卫生部. 手足口病诊疗指南(2010 年版) [J].国际呼吸杂志, 2010, 30(24): 1473-1475.
[6] 卫生部手足口病临床专家组. 肠道病毒7l 型(EV71) 感染 重症病例临床救治专家共识[J]. 中华儿科杂志, 201l, 49(9): 675-678.
[7] 李侗曾, 姜太一, 梁连春. 手足口病患儿血清细胞因子水平 变化及免疫球蛋白治疗效果分析[J]. 国际儿科学杂志, 2014, 41(4): 427-430.
[8] 黄小霏, 范联, 陈国华. 手足口病患儿血清 IL-6、IL-10、IL-17 水平的变化及其临床意义[J]. 重庆医学, 2012, 41(30): 3157-3159.
[9] Chen SC, Chang HL, Yan TR, et al. An eight-year study of epidemiologic features of enterovirus 71 infection in Taiwan[J]. Am J Trop Med Hyg, 2007, 77(1): 188-191.
[10] 吕鑫, 张育才. 微小RNA 在脓毒症发病机制的作用研究进 展[J]. 中华实用儿科临床杂志, 2014, 29(18): 1416-1418.
[11] Tisoncik JR, Korth MJ, Simmons CP, et al. Into the eye of the cytokine storm[J]. Microbiol Mol Biol Rev, 2012, 76(1): 16-32.
[12] Lin TY, Hsia SH, Huang YC, et al. Proinflammatory cytokine reactions in enterovirus 71 infections of the central nervous system[J]. Clin Infect Dis, 2003, 36(3): 269-274.
[13] 陈艳丽, 郭富桃. 脓毒症休克心肌顿抑严重程度判断的临床 研究[J]. 中国当代医药, 2012, 19(18): 8-10.
[14] 许煊, 李丹丹, 何瑛, 等. 连续血液净化在严重脓毒症患儿 中的应用及对炎性因子白细胞介素-6 和肿瘤坏死因子-α 的调节[J]. 中国小儿急救医学, 2013, 20(1): 48-51.
[15] 冯丽, 高歌. 白介素-10 与炎症性肠病[J].国外医学·消化 系疾病分册, 2004, 24(6): 329-331.
[16] 邱泽亮, 张宁, 宁易平, 等. 间歇性高容量血液滤过对严重 脓毒症炎症介质的影响[J]. 实用医学杂志, 2012, 28(3): 392-395.
[17] 霍习敏, 曹利静, 徐梅先, 等. 严重脓毒症患儿连续性静脉 一静脉血液滤过疗效及治疗时间研究[J]. 中国小儿急救医 学, 2014, 21(1): 28-30.

基金

河北省2015年度医学科学研究重点课题计划(20150559)。

PDF(1167 KB)
HTML

Accesses

Citation

Detail

段落导航
相关文章

/