摘要：
目的 探讨连续性静脉-静脉血液透析滤过(CVVHDF)在抢救儿童重症川崎病合并多器官功能障碍综合征(MODS)中的作用.方法 回顾性总结2015年11月至2017年10月上海交通大学附属儿童医院重症医学科(PICU)收治的川崎病合并MODS共5例患儿,采用CVVHDF辅助治疗,分析CVVHDF前后血液炎症细胞因子水平、器官功能变化与转归情况,组间比较采用Wilcoxon检验.结果 5例重症川崎病合并MODS患儿转入PICU时儿童危重评分(PCIS)74.0(70.0,81.0)分,第3代小儿死亡风险评分(PRISMⅢ)14.5(12.5,17.0)分.CVVHDF治疗时间46.0(24.5,48.0)h,均存活出院.CVVHDF治疗后白细胞介素6(IL-6) [0.4(0.1,28.8)比142.0(123.1,1 454.6) ng/L,Z=-2.023,P=0.043],肿瘤坏死因子α(TNF-α) [0.1 (0.1,9.3)比1.7(1.1,30.0) ng/L,Z=-2.023,P=0.0431,血乳酸[1.2(1.1,1.4)比2.5 (2.4,2.7) mmol/L,Z=-2.041,P=0.041],动脉氧分压(PaO2)/吸入氧浓度(FiO2)380.0(182.5,397.5)比160.0(52.5,185.0)mmHg(1 mmHg=0.133 kPa),Z=2.041,P=0.041]均明显改善;合并肝肾功能障碍的患儿总胆红素(TBIL)[(14.9±1.3)比(86.4±9.9) μmol/L],血肌酐(Cr)f2例,24.0比103.0 μmol/L,38.0比142.0 μmol/L]均恢复正常.结论 CVVHDF辅助抢救川崎病合并MODS能降低血液IL-6、TNF-α等炎症细胞因子水平,改善脏器功能,可能是重症川崎病合并MODS抢救有效辅助治疗手段.%Objective To explore the effects of continuous veno-venous hemodiafiltration (CVVHDF) as a rescue therapy in children with Kawasaki disease (KD) complicated with multiple organ dysfunction syndrome (MODS).Methods The medical records of 5 patients diagnosed as KD with MODS treated with CVVHDF,who were admitted to pediatric intensive care unit (PICU) of Shanghai Children's Hospital from November 2015 to October 2017 were retrospectively collected.The inflammatory factors and parameters of organ function before and after CVVHDF treatment were analyzed.Wilcoxon test was used to compare the changes of parameters before and after CVVHDF treatment.Results The pediatric critical illness score (PCIS) and the pediatric risk of score mortality score Ⅲ (PRISM Ⅲ) were 74.0 (70.0,81.0) and 14.5 (12.5,17.0),respectively.The duration of CVVHDF treatment was 46.0 (24.5,48.0) h.The levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-c),blood lactic acid were significantly decreased after the CVVHDF treatment (0.4 (0.1,28.8) vs.142.0 (123.1,1 454.6) ng/L,Z=-2.023,P=0.043;0.1 (0.1,9.3) vs.1.7(1.1,30.0) ng/L,Z=-2.023,P=0.043;1.2(1.1,1.4) vs.2.5(2.4,2.7) mmol/L,Z=-2.041,P=0.041 respectively).Moreover,the lung,liver and kidney function were significantly improved as indicated by the ratio of PaO2 to FiO2 (380.0 (182.5,397.5) vs.160.0 (52.5,185.0)mmHg (1 mmHg=0.133 kPa),Z=2.041,P=0.041),the level of total bilimbin ((14.9±1.3) vs.(86.4±9.9) μmol/L),and the levels of creatinine (2 cases:24.0 vs.103.0 μmol/L,38.0 vs.142.0 μmol/L).Conclusion CVVHDF as an adjuvant therapy can rapidly reduce the levels of IL-6 and TNF-α,and improve the organ functions in children with KD complicated with MODS.
