目的  探讨连续性静脉-静脉血液透析滤过(continuous veno-venous hemodiafiltration，CVVHDF)+血液灌流(hemoperfusion,HP)对脓毒性休克患儿体内炎症因子清除及预后的影响。 方法 本研究为一项前瞻性随机对照研究，研究对象为2021年10月—2024年7月入住河南医药大学(原新乡医学院)第一附属医院儿童重症监护室(pediatric intensive care unit，PICU)的年龄为0～14岁且诊断为脓毒性休克的患儿，按照随机数字表法(1:1比例)分为血液净化治疗组和常规治疗组。观察2组治疗前及治疗72 h后外周血血清中NOD样受体热蛋白结构域相关蛋白3(NOD-like receptor thermal protein domain associated protein 3，NLRP3)炎症小体等炎症因子及总住院时间、PICU住院时间、28 d内的临床结局等指标。 结果 共纳入血液净化治疗组患儿33例，常规治疗组33例。治疗前，2组患儿NLRP3(t=-1.256,P=0.214)、白细胞计数(white blood cell,WBC)(t=-1.086,P=0.282)、降钙素原(procalcitonin，PCT)(t=0.913,P=0.365)、白细胞介素-6(interleukin-6,IL-6)(t=0.731,P=0.467)、C-反应蛋白(C-reactive protein，CRP)(t=0.701,P=0.486)、血乳酸(lactate，Lac)(t=-0.942,P=0.350)均无明显差异；治疗后，血液净化治疗组上述指标均低于常规治疗组(NLRP3：t=-7.597,P＜0.001；WBC：t=-3.034,P=0.004；PCT：t=-4.930,P＜0.001；IL-6：t=-4.357,P＜0.001；CRP：t=-5.002,P＜0.001；Lac：t=-2.102,P=0.040)。受试者工作特征(receiver operating characteristic，ROC)曲线及ROC曲线下面积(area under the curve，AUC)显示：NLRP3(AUC=0.842，95% CI：0.704～0.980，P=0.001)、IL-6(AUC=0.741，  95% CI：0.510～0.971，P=0.021)、Lac(AUC=0.784，95% CI：0.627～0.940，P=0.007)对患儿的28 d死亡事件具有一定的预测价值。血液净化治疗组28 d死亡率较常规治疗组降低(3.0%比24.2%,χ²=4.632,   P=0.031)，总住院时间(t=-2.157,P=0.037)和PICU住院时间(t=-2.108,P=0.039)均缩短。 结论 CVVHDF+HP较常规治疗能更有效地清除脓毒性休克患儿体内的炎症因子，降低死亡率，缩短住院时间，改善预后。NLRP3、IL-6、Lac能够较好地预测患儿的死亡事件。

Objective  To investigate the effects of continuous veno-venous hemodiafiltration (CVVHDF) combined with hemoperfusion (HP) on the clearance of inflammatory cytokines and prognosis in children with septic shock. Methods  This study was a prospective randomized controlled trial. The subjects were children aged 0-14 years diagnosed with septic shock who were admitted to the Pediatric Intensive Care Unit (PICU) of the First Affiliated Hospital of Henan Medical University (formerly Xinxiang Medical University) from October 2021 to July 2024. They were randomly assigned (1:1 ratio) via a random number table to either a blood purification treatment group or a conventional treatment group. The following parameters were observed before treatment and 72 hours after treatment: serum levels  of inflammatory cytokines including NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome in peripheral blood, as well as total hospital length of stay, PICU length of stay, and 28‑day clinical outcomes. Results  A total of 33 children were enrolled in the blood purification group and 33 in the conventional treatment group. Before treatment, there were no significant differences between the two groups in NLRP3 (t=-1.256, P=0.214), white blood cell count (WBC) (t=-1.086, P=0.282), procalcitonin (PCT) (t=0.913, P=0.365), interleukin‑6 (IL‑6) (t=0.731, P=0.467), C‑reactive protein (CRP) (t =0.701, P=0.486), or blood lactate (Lac) (t=-0.942, P=0.350). After treatment, all the above parameters were significantly lower in the blood purification group than in the conventional treatment group (NLRP3:t=-7.597, P<0.001; WBC:t=-3.034, P=0.004; PCT: t=-4.930,P＜0.001; IL‑6: t=-4.357, P＜0.001; CRP: t=-5.002, P<0.001; Lac: t=-2.102, P=0.040). Receiver operating characteristic (ROC) curves and areas under the curve (AUC) showed that NLRP3 (AUC=0.842, 95% CI: 0.704～0.980, P=0.001), IL‑6(AUC=0.741, 95% CI:0.510～0.971, P=0.021), and Lac (AUC=0.784, 95% CI: 0.627～0.940, P=0.007) had certain predictive value for 28‑day mortality. The 28‑day mortality rate in the blood purification group was significantly lower than that in the conventional treatment group (3.0% vs. 24.2%, χ²=4.632, P=0.031), and both total hospital stay (t=-2.157, P=0.037) and PICU stay (t=-2.108, P=0.039) were shortened.  Conclusion  Compared with conventional treatment, CVVHDF combined with HP can more effectively clear inflammatory cytokines in children with septic shock, reduce mortality, shorten hospital stay, and improve prognosis. NLRP3, IL‑6, and Lac are good predictors of mortality in these children.