血浆置换联合连续性静脉-静脉血液滤过透析治疗在儿童川崎病休克综合征中的临床应用

Clinical application of plasma exchange combined with continuous veno-venous hemofiltration dialysis in children with refractory Kawasaki disease shock syndrome

摘要:

目的 探讨血浆置换联合连续性血液净化在救治难治性川崎病休克综合征（Kawasaki disease shock syndrome，KDSS）中的作用。方法 收集2019年1月—2022年8月在湖南省儿童医院重症医学科住院治疗的35例KDSS患儿为研究对象，按照是否实施血浆置换+连续性静脉-静脉血液滤过透析治疗分为净化组（12例）和常规组（23例），比较两组患儿的临床资料、实验室指标及预后情况。结果 净化组患儿休克恢复时间、重症监护病房住院时间均短于常规组，病程中脏器受累个数少于常规组（P<0.05）。净化组血液净化治疗后血白细胞介素-6、肿瘤坏死因子α、肝素结合蛋白、脑钠肽水平较血液净化治疗前均下降（P<0.05），而常规组治疗后这些指标较治疗前升高（P<0.05）。净化组患儿治疗后每搏输出变异、胸腔液体水平、外周血管阻力均随时间推移呈下降趋势，心输出量随着治疗呈上升趋势。结论 血浆置换联合连续性静脉-静脉血液滤过透析治疗KDSS可减轻炎症反应，平衡血管内外的液体平衡，缩短病程、休克时间及重症监护病房住院时间。

Abstract:

Objective To study the role of plasma exchange combined with continuous blood purification in the treatment of refractory Kawasaki disease shock syndrome (KDSS).Methods A total of 35 children with KDSS who were hospitalized in the Department of Pediatric Intensive Care Unit, Hunan Children's Hospital, from January 2019 to August 2022 were included as subjects. According to whether plasma exchange combined with continuous veno-venous hemofiltration dialysis was performed, they were divided into a purification group with 12 patients and a conventional group with 23 patients. The two groups were compared in terms of clinical data, laboratory markers, and prognosis.Results Compared with the conventional group, the purification group had significantly shorter time to recovery from shock and length of hospital stay in the pediatric intensive care unit, as well as a significantly lower number of organs involved during the course of the disease (P<0.05). After treatment, the purification group had significant reductions in the levels of interleukin-6, tumor necrosis factor-α, heparin-binding protein, and brain natriuretic peptide (P<0.05), while the conventional group had significant increases in these indices after treatment (P<0.05). After treatment, the children in the purification group tended to have reductions in stroke volume variation, thoracic fluid content, and systemic vascular resistance and an increase in cardiac output over the time of treatment.Conclusions Plasma exchange combined with continuous veno-venous hemofiltration dialysis for the treatment of KDSS can alleviate inflammation, maintain fluid balance inside and outside blood vessels, and shorten the course of disease, the duration of shock and the length of hospital stay in the pediatric intensive care unit.