目的 探讨连续性血液净化（CBP）在救治新生儿多器官功能障碍综合征（MODS）中的应用效果及并发症。方法 回顾性分析2015年11月至2019年4月于新生儿重症监护室（NICU）住院并应用CBP治疗的21例MODS新生儿的临床资料。观察CBP治疗前，治疗后6、12、24、36 h，以及治疗结束时患儿的临床指标变化，评估CBP治疗的疗效及安全性。结果 21例经CBP治疗的MODS患儿中，17例治疗有效，有效率为81%。在治疗有效的患儿中，与CBP治疗前比较，氧合指数在治疗6 h时明显改善，尿量在治疗24 h时明显增多，血压在治疗24 h后稳定在正常范围，血管活性药物肾上腺素及多巴胺在治疗6 h时明显减量（P < 0.05）；血K+水平在治疗6 h时明显下降，血pH值在治疗12 h时明显改善，血乳酸、血肌酐及尿素氮水平在治疗12 h时明显下降（P < 0.05）。21例患儿在CBP治疗过程中，发现6例出现血小板减少，1例出现堵膜，1例出现出血，未出现低体温、低血压、感染等CBP治疗相关并发症。结论 CBP技术救治新生儿MODS疗效显著，且安全可行，并发症少。
Abstract
Objective To study the clinical effect and complications of continuous blood purification (CBP) in the treatment of multiple organ dysfunction syndrome (MODS) in neonates. Methods A retrospective analysis was performed for the clinical data of 21 neonates with MODS who were admitted to the neonatal intensive care unit from November 2015 to April 2019 and were treated with CBP. Clinical indices were observed before treatment, at 6, 12, 24, and 36 hours of CBP treatment, and at the end of treatment to evaluate the clinical effect and safety of CBP treatment. Results Among the 21 neonates with MODS undergoing CBP, 17 (81%) had response to treatment. The neonates with response to CBP treatment had a significant improvement in oxygenation index at 6 hours of treatment, a significant increase in urine volume at 24 hours of treatment, a stable blood pressure within the normal range at 24 hours of treatment, and significant reductions in the doses of the vasoactive agents epinephrine and dopamine at 6 hours of treatment (P < 0.05), as well as a significant reduction in serum K+ level at 6 hours of treatment, a significant improvement in blood pH at 12 hours of treatment, and significant reductions in blood lactic acid, blood creatinine, and blood urea nitrogen at 12 hours of treatment (P < 0.05). Among the 21 neonates during CBP treatment, 6 experienced thrombocytopenia, 1 had membrane occlusion, and 1 experienced bleeding, and no hypothermia, hypotension, or infection was observed. Conclusions CBP is a safe, feasible, and effective method for the treatment of MODS in neonates, with few complications.
关键词
多器官功能障碍综合征 /
连续性血液净化 /
疗效 /
新生儿
Key words
Multiple organ dysfunction syndrome /
Continuous blood purification /
Clinical effect /
Neonate
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