摘要
目的探讨两种不同血液净化方法[腹膜透析(PD)、连续性静脉静脉血液滤过(CVVH)]治疗儿童蜂蜇伤并发急性肾损伤(AKI)的疗效。方法回顾性分析4所医院2000年以来收治的蜂蜇伤并发AKI的22例患儿临床资料,其中3例未行血液净化治疗,设为对照组;15例行PD治疗,设为PD治疗组,并按治疗转归细分为死亡组和存活组;4例行CVVH,设为CVVH治疗组。对比分析各组的病死率以及PD治疗组中死亡组和存活组的平均PD总液量及PD治疗时间,并将PD治疗组和CVVH治疗组治疗前的APACHEⅡ和SOFA评分、平均ICU住院时间以及PD治疗前和治疗48 h后死亡组和存活组的APACHEⅡ评分、SOFA评分、氧合指数、血浆肌酐(Cr)、尿素氮(BUN)、平均动脉压(MAP)等指标进行比较。结果 (1)对照组的病死率明显高于PD治疗组及CVVH治疗组(P<0.05),PD治疗组的病死率明显高于CVVH治疗组(P<0.05);(2)PD治疗组和CVVH治疗组行血液净化治疗前APACHEⅡ和SOFA评分无明显差别(P>0.05),但PD治疗组的平均ICU住院时间明显长于CVVH治疗组(P<0.05);(3)PD治疗组中,死亡组APACHEⅡ和SOFA评分始终明显高于存活组,平均ICU住院时间、PD总液量、PD治疗时间明显高于或长于存活组(P<0.01);(4)治疗48 h后,死亡组PD APACHEⅡ评分、SOFA评分、氧合指数、Cr、BUN、MAP均无明显改善(P>0.05),而存活组均明显改善(P<0.01)。结论血液净化是治疗儿童蜂蜇伤并发AKI的一种有效手段,CVVH治疗儿童蜂蜇伤并发AKI的疗效优于PD;早期PD可改善儿童蜂蜇伤并发AKI的预后;APACHEⅡ和SOFA评分对判断儿童蜂蜇伤并发AKI的预后有指导意义。
Objective To discuss the curative effects of two different mothods of blood purification [ peritoneal dialysis （PD） and continuous veno-venous hemofiltration（CVVH）] on children with acute kidney injury（AKI） induced by wasp sting. Methods Retrospective analysis was made in the clinical data of 22 children with AKI induced by wasp sting from 4 hospitals. Three cases which did not receive the blood purification were chosen as control group. Fifteen cases that received the PD were chosen as PD group, and were further divided into death and survival group according to the treatment. Four cases that received CVVH were chosen as CVVH group. Comparatively analysis was made in the death rate of different groups and the average total volume of PD and the length of PD treatment of the death and survival group. Comparison was also made in APACHE II and sequential organ failure assessment（SOFA） scores and the average length of time in ICU before the treatment between the PD and CVVH group and in the APACHE 11 and SOFA scores, oxygenate index, serum creatinine（ Cr）, blood urea nitrogen（ BUN）, and mean arterial pressure（MAP） before and 48 h after the treatment between the death and survival group. Results （ 1 ） The mortality rate of the control group was significantly higher than that of PD group and CVVH group（ P 〈 O. 05 ）, and that of the PD group was significantly higher than that of the CVVH group（ P 〈 0.05 ）. （2） There was no significant difference in the APACHE ]I and SOFA scores before the blood purification between the PD and CVVH group （ P 〉 O. 05 ）. But the average length of time in ICU in the PD group was significantly longer than that in the CVVH group. （ 3 ） In the PD group, the APACHE I1 and SOFA scores of the death group were higher than those of the survival group. The length of time in ICU, total volume of PD, and the length of PD treatment in the death group were higher or longer than those in the survival group （P 〈 0.05）. （4）There was no sig
出处
《西南国防医药》
CAS
2013年第10期1062-1065,共4页
Medical Journal of National Defending Forces in Southwest China
基金
四川省卫生厅科研项目(100189)
关键词
蜂蜇伤
急性肾损伤
儿童
腹膜透析
连续性静脉-静脉血液滤过
APACHE
Ⅱ评分
SOFA评分
wasp sting
acute kidney injury
children
peritoneal dialysis
continuous veno-venous hemofiltration
APACHEⅡ scoring
sequential organ failure assessment scoring
