中国实用儿科杂志

中国实用儿科杂志

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危重症患儿血液净化治疗的并发症和意外事件与防治

杨镒宇，郑亦男，曾萍，陶建平，洪婕，张剑晖，朱翠平，常平，曾其毅   

  1. 广东省广州市儿童医院PICU，广州510120
  • 收稿日期:2006-09-15 修回日期:2007-01-15 出版日期:2007-05-06 发布日期:2007-05-06
  • 通讯作者: 曾其毅

Complications and incidences from blood purification for pediatric severe patients and their prevention and treatment.

YANG Yi-yu,ZHENG Yi-nan,ZENG Ping,et al.   

  1. PICU of Guangzhou Children's Hospital,318 Renmin Zhong Rd，Guangzhou 510120,Guangdong，China
  • Received:2006-09-15 Revised:2007-01-15 Online:2007-05-06 Published:2007-05-06

摘要： 目的探讨血液净化技术(BP)在小儿危重症治疗中的并发症和意外事件的防治方法。 方法2004-03—2006-03，对广州市儿童医院儿科中心监护室(PICU)危重患儿实施血液净化治疗，并进行危险因素的监控与防治。 结果(1)对16例入选患儿进行了BP治疗，共32次。存活12例，死亡4例，治疗过程中死亡和治疗后24h内死亡分别为1例和3例。(2)BP治疗前后炎症指标如体温、心率、呼吸、WBC计数、ESR、CRP下降，差异均有显著性(P值<0.001)。(3)在32次BP治疗术中出现各类并发症28次。发生次数最多的是循环系统并发症包括血压明显下降、不稳、休克或高血压共10次，其他并发症有穿刺点出血不止、血肿或全身出血，低温，肺氧合功能明显恶化，肺出血；意外事件发生6次，包括滤器堵塞、血浆分离器漏血等。(4)BP治疗术中也有酸碱平衡失调、血清电解质紊乱等并发症。经过床边监护和相应治疗大部分并发症和全部意外事件得以纠治。 结论危重患儿实施血液净化治疗时存在各种危险因素，全程监控可保障治疗安全并可及时纠治并发症和全部意外事件。

关键词: 血液净化技术, 小儿危重症, 并发症, 意外事件, 防治

Abstract: AbstractObjectiveTo investigate the complications and incidences from blood purification (BP) for pediatric severe patients and their prevention and treatment. MethodsThe risk factors were monitored and corrected while the pediatric severe patients were treated with BP in PICU of children's hospital. Results1) There were 16 children treated with BP for 32 times.Finally,there were 12 survival cases and 4 deaths.2)After BP treatment there were decreases in inflammatory indexes,all P value <0.001.3)There were 28 times of complications during 32 times of BP.The most frequent complication happened in circulative system,covering hypotension,unstable blood pressure,shock and hypertension.Others were bleeding,hypothermia,deteriorated oxygenation and pulmonary hemorrhage.There were 6 incidences,including filter blockage,leakage of plasma segregator.4)There were also disorders of acid-base and electrolytes during BP.Most of the complications and all of the incidences were corrected after related treatments under bed-side care. ConclusionThere are all kinds of risk factors during BP for pediatric severe patients,and most of the complications and all of the incidences can be corrected in time if the critical care for the whole course guarantees the therapeutic safety.

Key words: Incidence, Prevention and treatment , Pediatric severe patients, Complication