连续性血液滤过对危重型手足口病儿童炎症介质及血流动力学的影响

Effect of continuous hemofiltration on inflammatory mediators and hemodynamics in children with severe hand, foot and mouth disease

摘要:

目的 探讨连续性静脉-静脉血液滤过(CVVH)对于危重型手足口病(HFMD)患儿炎症介质及血流动力学的影响,评估临床疗效。方法 36 例HFMD 第4 期患儿随机分为常规治疗组和CVVH 治疗组,每组18 例。CVVH 组在常规治疗基础上行CVVH 治疗。于治疗前、治疗24 h、48 h 检测外周静脉血IL-2、IL-6、IL-10、TNF-α、乳酸浓度以及心率、血压、左心室射血分数。结果 治疗24 h 后,常规治疗组血IL-2 浓度较治疗前明显降低(P<0.01),CVVH 组血IL-2、IL-6、IL-10、TNF-α 浓度均低于治疗前和常规治疗组(P<0.05)。治疗48 h 后,两组各炎症因子浓度较治疗前和治疗24 h 均明显降低(P<0.01),且CVVH 组低于常规治疗组(P<0.01)。治疗48 h 后两组患儿的心率、收缩压、血乳酸均明显降低,左心室射血分数明显增高(P<0.01);CVVH 组除收缩压以外的其他指标与常规治疗组比较,差异有统计学意义(P<0.01)。结论 CVVH 能有效清除危重型手足口病患儿体内的炎症因子,同时能降低心率、静脉血乳酸,改善心功能。

Abstract:

Objective To investigate the effect of continuous veno-venous hemofiltration (CVVH) on inflammatory mediators in children with severe hand, foot and mouth disease (HFMD), and to investigate its clinical efficacy. Methods A total of 36 children with stage IV HFMD were enrolled and randomly divided into conventional treatment group and CVVH group (n=18 each). The children in the CVVH group were given CVVH for 48 hours in addition to the conventional treatment. The levels of interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) and lactic acid in peripheral venous blood, heart rate, blood pressure, and left ventricular ejection fraction were measured before treatment and after 24 and 48 hours of treatment. Results After 24 hours of treatment, the conventional treatment group had a significantly reduced serum IL-2 level (P<0.01), and the CVVH treatment group had significantly reduced serum levels of IL-2, IL-6, IL-10, and TNF-α (P<0.05). After 48 hours of treatment, both groups had significantly reduced serum levels of IL-2, IL-6, IL-10, and TNF-α (P<0.01), and the CVVH group had significantly lower levels of these inflammatory factors than the conventional treatment group (P<0.01). After 48 hours of treatment, heart rate, systolic pressure, and blood lactic acid level were significantly reduced, and left ventricular ejection fraction was significantly increased in both groups, and the CVVH group had significantly greater changes in these indices except systolic pressure than the conventional treatment group (P<0.01). Conclusions CVVH can effectively eliminate inflammatory factors, reduce heart rate and venous blood lactic acid, and improve heart function in children with severe HFMD.