儿科危重症专栏

连续性血液净化治疗新生儿脓毒性休克伴急性肾损伤临床分析

  • 许景林 ,
  • 杨汉松 ,
  • 陈新华 ,
  • 陈江滨 ,
  • 李晓庆 ,
  • 张伟峰 ,
  • 陈冬梅
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  • 1.福建医科大学研究生院(福建福州 350000)
    2.福建医科大学教学医院 泉州市儿童医院新生儿科(福建泉州 362000)

收稿日期: 2022-10-30

  网络出版日期: 2023-06-12

Clinical analysis of continuous blood purification in the treatment of neonatal septic shock with acute kidney injury

  • Jinglin XU ,
  • Hansong YANG ,
  • Xinhua CHEN ,
  • Jiangbin CHEN ,
  • Xiaoqing LI ,
  • Weifeng ZHANG ,
  • Dongmei CHEN
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  • 1. The Graduate School of Fujian Medical University, Fuzhou 35000, Fujian, China
    2. Teaching Hospital of Fujian Mcdical University, Quanzhou Children’s Hospital, Quanzhou 362000, Fujian, China

Received date: 2022-10-30

  Online published: 2023-06-12

摘要

目的 分析床旁连续性血液净化(CBP)技术治疗新生儿脓毒性休克伴急性肾损伤(AKI)的临床指标变化。方法 回顾性分析2015年1月至2022年5月新生儿重症监护病房接受CBP治疗的脓毒性休克伴AKI患儿的临床资料。结果 纳入脓毒性休克伴AKI新生儿15例。死亡8例,病死率53.3%。其中男10例,早产儿5例,入院日龄1.0(1.0~6.0)d,出生胎龄38.0(34.0~41.0)周,出生体重3 100.0(2 850.0~3 250.0)g,AKI分期2(2~3)期。所有患儿均需机械通气呼吸支持及使用血管活性药物,正性肌力药物评分(VIS)110.0(64.0~320.0)分。CBP治疗24 h和治疗结束组平均动脉压(MAP)高于治疗前组,尿量多于治疗前组,血清肌酐和尿素氮低于治疗前组,差异均有统计学意义(P<0.05)。最常见CBP相关不良事件为血小板减少症(45.5%)。单因素分析未发现CBP死亡相关危险因素(P>0.05)。结论 床旁CBP可以及时维持脓毒性休克伴AKI新生儿的血流动力学稳定,纠正休克,明显改善肾功能,安全性好。

本文引用格式

许景林 , 杨汉松 , 陈新华 , 陈江滨 , 李晓庆 , 张伟峰 , 陈冬梅 . 连续性血液净化治疗新生儿脓毒性休克伴急性肾损伤临床分析[J]. 临床儿科杂志, 2023 , 41(6) : 436 -441 . DOI: 10.12372/jcp.2023.22e1459

Abstract

Objective To analyze the clinical indicators of continuous blood purification (CBP) in the treatment of neonatal septic shock with acute kidney injury (AKI). Methods The clinical data of neonates with septic shock and AKI treated with CBP in the neonatal intensive care unit from January 2015 to May 2022 were retrospectively analyzed. Results Fifteen neonates with septic shock and AKI were included in this study, and eight patients died with a mortality rate of 53.3%. Among them, 10 were boys and 5 were premature infants. The age of admission was 1.0 (1.0-6.0) days, the gestational age was 38.0 (34.0-41.0) weeks, the birth weight was 3100.0 (2850.0-3250.0) grams, and the AKI stage was 2 (2-3). All children needed mechanical ventilation and vasoactive drugs. The vasoactive inotropic score (VIS) was 110.0 (64.0-320.0). The mean arterial pressure (MAP) and urine output of the CBP treatment group at 24 hours and at the end of treatment were higher than that of the pre-treatment group, and the serum creatinine and urea nitrogen were lower than that of the pre-treatment group, the difference was statistically significant (P<0.05).The commonest CBP related adverse event was thrombocytopenia (45.5%). Univariate analysis showed that no risk factors for death related to CBP were found (P>0.05). Conclusions Bedside CBP can timely maintain hemodynamic stability in neonates with septic shock and AKI, correct shock, and significantly improve the renal function. It has good security.

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