中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (01): 35-38.doi: 10.3969/j.issn.1671-4091.2017.01.009

• 临床研究 • 上一篇    下一篇

危重患儿持续性静脉-静脉血液滤过治疗剂量的探讨

董伟1,梁华般1,宋利1,刘双信1,李锐钊1, 陈源汉1, 莫立仪1,李志莲1, 史伟1,梁馨苓1   

  1. 1广东省人民医院(广东省医学科学院)
  • 收稿日期:2016-06-29 修回日期:2016-11-09 出版日期:2017-01-12 发布日期:2017-01-12
  • 通讯作者: 梁馨苓 13808829770@139.com E-mail:13808829770@139.com
  • 基金资助:

    国家临床重点专科建设项目“十二五”国家科技支撑计划项目(2011BAI10B08)；广东省自然科学基金(2014A03031345)

Effects of different doses of continuous veno-venous hemofiltration on outcome of critically ill children

  • Received:2016-06-29 Revised:2016-11-09 Online:2017-01-12 Published:2017-01-12

PDF

405

摘要： 目的观察持续静脉-静脉血液滤过(continuous venous-venous hemofiltration，CVVH)治疗剂量对危重患儿预后的影响。方法回顾性纳入2010 年1 月～2015 年12 月期间广东省人民医院接受CVVH 治疗的危重患儿。比较CVVH 处方低剂量组[≤35ml/(kg·h)]及高剂量组[＞35ml/(kg·h)]间的预后。结果高剂量组和低剂量组30 天住院死亡率(38.5%比46.2%，χ2=0.265，P =0.607)、总住院时间[15(13,21) 比17(9,24)，Z=- 0.239，P =0.811] 及ICU 内住院时间[13(6,21) 比12(6,17)，Z=- 0.448, P =0.654]均无统计学差异。在Cox 回归中对其他危险因素校正后，高剂量组仍未能减少住院死亡(HR0.768,95% CI,0.261～2.264，P=0.632)。结论超过35ml/(kg·h)的CVVH 处方剂量未能改善危重患儿预后。

关键词: 死亡率, 剂量, 肾脏替代治疗, 持续性静脉-静脉血液滤过, 危重患儿

Abstract: Objective The aim of this study is to evaluate the effect of different doses of continuous venovenous hemofiltration (CVVH) on outcome of critically ill children. Methods The clinical data of critically ill children treated with CVVH in the Pediatric Intensive Care Unit of Guangdong General Hospital between Jan. 2010 and Dec. 2015 were retrospectively analyzed. They were divided into two groups based on the prescribed effluent volume: lower dose group (prescribed effluent volume ≤35 ml/kg/h) and higher dose group (prescribed effluent volume ＞35ml/kg/h). The in-hospital outcomes including 30 days in-hospital mortality, lengths of stay in hospital and in ICU were compared between the two groups. Results A total of 39 critically ill children were enrolled in this study. The 28 days in-hospital mortality was 43.6%, and the median lengths of stay in hospital and in ICU were 16 (10,24) and 19 (12,30) days respectively. There were no significant differences in 30 days in-hospital mortality (38.5% vs. 46.2%, 0.265, P=0.607), lengths of stay in hospital [15 (13,21) vs. 17 (9,24), Z=-0.239, P=0.811] and in ICU [13 (6,21) vs. 12 (6,17), Z=-0.448, P= 0.654] between the two groups. Multivariate Cox’s proportional hazards regression found that the higher dose group was not associated with the lower risk of in-hospital death (HR=0.768; 95% CI 0.261～2.264, P=0.632). Conclusions Effluent volume ＞35ml/kg/h was not related to the better outcome in hospital. Therefore, the CVVH dose for critically ill children can follow the guideline for adults that recommends the practical effluent volume of 20～25 ml/(kg•h) or prescribed effluent volume of 30～35ml/(kg•h).

Key words: Mortality, Dose, Renal Replacement therapy, Continuous venous- venous hemofiltration, Critically ill children