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目的分析连续性血液净化治疗(CBP)在小儿重症手足口病中的应用价值。方法选取病情符合手足口病重症病例危重型的患儿30例,随机分为对照组(常规治疗组)和CBP治疗组,每组15例。对照组给予常规药物治疗、机械通气治疗;CBP治疗组在常规治疗基础上联合行连续性静脉—静脉血液滤过治疗。监测2组患儿治疗前和治疗24 h后心率、血压、血乳酸及左心室射血分数等指标的变化情况,同时比较2组存活病例的机械通气时间、平均住院时间。结果对照组存活病例平均机械通气时间为(15.4±2.7)d,平均住院时间(21.2±3.5)d;CBP平均机械通气时间为(11.4±1.9)d,住院时间(18.7±2.0)d。治疗24 h后,2组收缩血压均较治疗前明显降低(P<0.01或P<0.05)。治疗24 h,CBP组心率、静脉血乳酸明显低于治疗前(P<0.01);左心室射血分数较治疗前升高(P<0.05)。CBP组治疗24 h后心率、血乳酸、血压均低于对照组,左心室射血分数高于对照组(P均<0.05)。结论 CBP能降低小儿重症手足口病患儿的心率、血压、血乳酸值同时改善心功能,对进一步提高危重症病例的抢救成功率、改善预后具有积极意义。
Objective To analyze the value of continuous blood purification (CBP) in pediatric severe hand-foot-mouth disease. Methods Thirty children with critically ill HFMD were selected and randomly divided into control group (conventional treatment group) and CBP treatment group (n = 15). The control group was given conventional drug treatment and mechanical ventilation. The CBP treatment group was treated with continuous veno-venous hemofiltration on the basis of routine treatment. The changes of heart rate, blood pressure, blood lactic acid and left ventricular ejection fraction before and 24 h after treatment were monitored in both groups. The mechanical ventilation time and the average length of stay of the two groups were also compared. Results The mean duration of mechanical ventilation in the control group was (15.4 ± 2.7) days and average duration of hospital stay was (21.2 ± 3.5) days. The average duration of CBP was (11.4 ± 1.9) days and hospital stay was (18.7 ± 2.0) days. After 24 hours of treatment, the systolic blood pressure in both groups was significantly lower than that before treatment (P <0.01 or P <0.05). After treatment for 24 h, the heart rate and venous blood lactate in CBP group were significantly lower than those before treatment (P <0.01). The left ventricular ejection fraction increased significantly (P <0.05). Heart rate, blood lactate and blood pressure in CBP group were lower than those in control group 24 hours after treatment, and the left ventricular ejection fraction was higher than that in control group (all P <0.05). Conclusion CBP can reduce the heart rate, blood pressure and blood lactic acid in children with severe hand-foot-mouth disease in children and improve heart function at the same time. It is of positive significance to further improve the rescue success rate and prognosis of critically ill patients.