儿童重症监护室血浆置换治疗单中心回顾性研究

Therapeutic plasma exchange in the pediatric intensive care unit: a single-center retrospective study

摘要:

目的 总结儿童重症监护室患儿进行血浆置换治疗（therapeutic plasma exchange，TPE）的适应证和并发症。 方法 回顾性分析2015年3月至2021年3月在湖南省儿童医院重症医学科行TPE患儿的病历资料，分析TPE适应证和并发症，并与美国血液分离学会（American Society for Apheresis，ASFA）适应证类别比较。 结果 196例患儿共进行了405次TPE，76例（38.8%）患儿联合了连续性肾脏替代治疗，147例（75.0%）患儿存活，其中神经疾病存活率最高（27/29，93%）。TPE适应证前3位分别是血液病（61/196，31.1%）、脓毒血症合并多器官功能障碍综合征（41/196，20.9%）、肝病（36/196，18.4%）。血液病患儿接受TPE总次数最多，为129次。研究对象适应证占比最高为ASFA Ⅲ类（150/196，76.5%），其次为ASFA Ⅰ类（22/196，11.2%），ASFA Ⅱ类（14/196，7.1%），不便分类（10/196，5.1%），无ASFA Ⅳ类。TPE并发症发生率为12.3%（50/405），以管路凝血（4.2%，17/405）和低血压（3.7%，15/405）为常见，无严重不良反应。 结论 TPE在经验丰富的儿童重症监护室可以安全地用于有适应证的儿童危重症患者救治。

Abstract:

Objective To study the indication for therapeutic plasma exchange (TPE) and related complications in children admitted to the pediatric intensive care unit. Methods A retrospective analysis was performed on the medical records of the children who received TPE in the Pediatric Intensive Care Unit, Hunan Children's Hospital, from March 2015 to March 2021. The indication for TPE and related complications were analyzed and compared with the American Society for Apheresis (ASFA) indication categories. Results A total of 405 TPE treatment sessions were performed for 196 children, among whom 76 children (38.8%) also received continuous renal replacement therapy and 147 children (75.0%) survived. The children with neurological diseases had the highest survival rate of 93.1% (27/29). The top three indications for TPE were hematologic diseases (61/196, 31.1%), sepsis with multiple organ dysfunction (41/196, 20.9%), and liver diseases (36/196, 18.4%). The children with hematologic diseases received the highest number of 129 TPE treatment sessions. The subjects with ASFA category Ⅲ indications accounted for the highest proportion of 76.5% (150/196), followed by those with ASFA category Ⅰ indications (11.2%, 22/196), ASFA category Ⅱ indications (7.1%, 14/196), and unknown category (5.1%, 10/196), and no ASFA category Ⅳ indications were observed. The incidence rate of TPE complications was 12.3% (50/405), and the most common complications were pipeline coagulation (4.2%, 17/405) and hypotension (3.7%, 15/405). No serious adverse events were observed. Conclusions TPE can be safely used for the treatment of critically ill children with indications in an experienced pediatric intensive care unit.