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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 investigate the efficacy of two different blood purification methods (peritoneal dialysis (PD) and continuous venovenous hemofiltration (CVVH)] in the treatment of bee stings in children with acute kidney injury (AKI). Methods The clinical data of 22 children with bee stings and AKI admitted in 4 hospitals since 2000 were retrospectively analyzed. Among them, 3 patients were treated with PD without blood purification and 15 as PD. , And were divided into death group and survival group according to treatment outcome; 4 CVVH patients were treated as CVVH treatment group. The mortality of each group and the average PD volume and PD treatment time of PD group and PD group were compared and analyzed. The APACHE II and SOFA scores before treatment, average ICU length of stay, APACHEⅡscore, SOFA score, oxygenation index, plasma creatinine (Cr), blood urea nitrogen (BUN) and mean arterial pressure (MAP) in PD group and surviving group before PD treatment and 48 hours after treatment were compared. Results The mortality of the control group was significantly higher than that of the PD group and the CVVH group (P <0.05). The mortality of the PD group was significantly higher than that of the CVVH group (P <0.05). (2) There was no significant difference in the APACHEⅡand SOFA scores between the CVVH treatment group and the control group (P> 0.05). However, the average length of ICU stay in the PD treatment group was significantly longer than that of the CVVH treatment group (P <0.05). (3) In the PD treatment group, The APACHEⅡand SOFA scores of the patients in the death group were always significantly higher than those in the survival group. The mean ICU length of hospital stay, total PD volume and PD treatment time were significantly higher than those in the survival group (P <0.01). (4) PD APACHEⅡ Score, SOFA score, oxygenation index, Cr, BUN, MAP had no significant improvement (P> 0.05), while the survival group were significantly improved (P <0.01). Conclusions Blood purification is an effective method to treat childhood bee stings complicated with AKI. CVVH is superior to PD in treating childhood bee stings complicated with AKI. Early PD can improve the prognosis of childhood bee stings complicated with AKI. The prognosis of childhood bee stings complicated with AKI is instructive.