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

doi:10.12372/jcp.2023.22e1459

Abstract

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.

Key words: continuous blood purification, sepsis, acute kidney injury, neonate

XU Jinglin, YANG Hansong, CHEN Xinhua, CHEN Jiangbin, LI Xiaoqing, ZHANG Weifeng, CHEN Dongmei. Clinical analysis of continuous blood purification in the treatment of neonatal septic shock with acute kidney injury[J].Journal of Clinical Pediatrics, 2023, 41(6): 436-441.

Figures/Tables 3

References 23

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时间点	MAP/mmHg	VIS评分	pH值	血乳酸/mg·dL^-1
治疗前	37.0(32.0~44.0)	91.0(61.0~253.0)	7.2(7.1~7.2)	142.8(99.1~184.9)
治疗12 h	54.0(38.0~55.0)	100.0(10.0~420.0)	7.2(7.2~7.4)	70.7(40.6~184.2)
治疗24 h	65.0(55.0~67.0)¹⁾	74.0(8.0~175.0)	7.3(7.2~7.4)	81.2(22.2~159.9)
治疗结束	61.0(57.0~68.0)¹⁾	7.0(5.0~9.0)	7.4(7.3~7.4)	32.9(8.4~57.7)
H值	10.01	0.95	7.27	5.87
P	0.019	0.814	0.064	0.118

时间点	尿量/mL·kg^-1·h^-1	血清肌酐/μmol·L^-1	尿素氮/mmol·L^-1	血钾/mmol·L^-1	血钠/mmol·L^-1
治疗前	0.28(0.00~0.57)	92.1(68.4~165.1)	7.5(5.1~15.4)	4.7(4.1~6.0)	131.7(127.2~139.7)
治疗12 h	0.80(0.14~2.16)	57.8(44.6~97.7)	7.6(4.4~9.8)	4.3(3.6~5.9)	142.7(131.4~145.5)
治疗24 h	1.77(0.85~3.70)¹⁾	44.3(32.6~71.4)¹⁾	5.9(4.8~6.4)¹⁾	4.4(3.8~5.3)	138.6(132.4~140.3)
治疗结束	1.47(1.10~2.82)¹⁾	39.5(30.2~66.6)¹⁾	4.7(3.6~8.2)¹⁾	4.3(3.9~4.9)	136.9(134.0~142.2)
H值	8.76	12.50	8.39	0.60	1.98
P	0.033	0.006	0.039	0.898	0.577

项目	存活组(n=7)	死亡组(n=8)	Z值	P
男[n(%)]	6(85.7)	4(50)	-	0.282¹⁾
胎龄[M(P₂₅~P₇₅)]/周	38.0(31.0~41.0)	39.0(35.0~41.0)	0.29	0.772
出生体重[M(P₂₅~P₇₅)]/g	3 200.0(1 800.0~3 250.0)	3 075.0(2 888.0~3 375.0)	0.06	0.954
AKI分期[M(P₂₅~P₇₅)]	2.0(2.0~3.0)	2.0(1.0~3.0)	0.79	0.428
NCIS评分[M(P₂₅~P₇₅)]	72.0(66.0~76.0)	64.0(61.0~76.0)	1.39	0.163
VIS评分[M(P₂₅~P₇₅)]	190.0(50.0~430.0)	91.0(70.0~270.0)	0.35	0.728
MAP[M(P₂₅~P₇₅)]/mmHg	37.0(29.0~44.0)	37.0(34.0~48.0)	0.23	0.817
pH值[M(P₂₅~P₇₅)]	7.2(7.1~7.2)	7.1(7.0~7.3)	0.58	0.563
血乳酸[M(P₂₅~P₇₅)]/mg·dL^-1	113.7(82.4~199.5)	166.4(92.4~188.5)	0.58	0.561
尿量[M(P₂₅~P₇₅)]/mL·kg^-1·h^-1	0.3(0.0~0.5)	0.34(0~0.75)	0.47	0.637
血清肌酐[M(P₂₅~P₇₅)]/μmol·L^-1	113.6(73.9~258.2)	92.1(39.8~128.1)	1.27	0.203
尿素氮[M(P₂₅~P₇₅)]/mmol·L^-1	12.9(6.9~17.6)	7.5(4.7~9.4)	1.50	0.132
CBP模式[n(%)]			-	1.000¹⁾
CVVHDF	3(42.9)	4(50.0)
CVVH	4(57.1)	4(50.0)
CBP启动日龄[M(P₂₅~P₇₅)]/d	10.0(3.0~47.0)	5.5(2.5~10.8)	0.81	0.415
CBP持续时间[M(P₂₅~P₇₅)]/h	44.0(28.0~88.0)	31.5(6.3~68.3)	0.58	0.562
导管置管位置[n(%)]
颈内静脉	7(100.0)	6(75.0)	-	0.467¹⁾
股静脉	5(71.4)	4(50.0)	-	0.608¹⁾
脐静脉	1(14.3)	1(12.5)	-	1.000¹⁾
锁骨下静脉	0(0.0)	3(37.5)	-	0.200¹⁾
CBP相关不良事件[n(%)]
血小板减少症	6(85.7)	4(50.0)	-	0.282¹⁾
出血或血栓	2(28.6)	4(50.0)	-	0.608¹⁾
管路堵塞	1(14.3)	2(25.0)	-	1.000¹⁾
低血压	1(14.3)	2(25.0)	-	1.000¹⁾

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

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