Wang F, Cui Y, Wang C X, Xiao T T, Chen R X, Zhang Y C
Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Tiao Tong University, Shanghai 200062, China.
Zhonghua Er Ke Za Zhi. 2018 Sep 2;56(9):691-694. doi: 10.3760/cma.j.issn.0578-1310.2018.09.011.
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). 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. The pediatric critical illness score (PCIS) and the pediatric risk of score mortality score Ⅲ (PRISMⅢ) 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-α), blood lactic acid were significantly decreased after the CVVHDF treatment (0.4 (0.1, 28.8) 142.0 (123.1, 1 454.6) ng/L, -2.023, 0.043; 0.1 (0.1, 9.3) 1.7(1.1, 30.0) ng/L, -2.023, 0.043; 1.2(1.1,1.4) 2.5(2.4, 2.7) mmol/L, =-2.041, =0.041 respectively). Moreover, the lung, liver and kidney function were significantly improved as indicated by the ratio of PaO(2) to FiO(2) (380.0 (182.5, 397.5) 160.0 (52.5, 185.0)mmHg (1 mmHg=0.133 kPa), 2.041, 0.041), the level of total bilirubin ((14.9±1.3) (86.4±9.9) μmol/L), and the levels of creatinine (2 cases: 24.0 103.0 μmol/L, 38.0 142.0 μmol/L). 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.
探讨连续性静脉-静脉血液透析滤过（CVVHDF）作为抢救治疗方法对川崎病（KD）合并多器官功能障碍综合征（MODS）患儿的疗效。回顾性收集2015年11月至2017年10月在上海儿童医学中心儿科重症监护病房（PICU）住院、诊断为KD合并MODS并接受CVVHDF治疗的5例患儿的病历资料。分析CVVHDF治疗前后的炎症因子及器官功能指标。采用Wilcoxon检验比较CVVHDF治疗前后各指标的变化。儿科危重病评分（PCIS）和儿科死亡风险评分Ⅲ（PRISMⅢ）分别为74.0（70.0，81.0）和14.5（12.5，17.0）。CVVHDF治疗时间为46.0（24.5，48.0）h。CVVHDF治疗后，白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平及血乳酸水平显著降低（0.4（0.1，28.8）比142.0（123.1，1454.6）ng/L，Z=-2.023，P=0.043；0.1（0.1，9.3）比1.7（1.1，30.0）ng/L，Z=-2.023，P=0.043；1.2（1.1，1.4）比2.5（2.4，2.7）mmol/L，Z=-2.041，P=0.041）。此外，氧合指数（PaO₂/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）、总胆红素水平（（14.9±1.3）比（86.4±9.9）μmol/L）及肌酐水平（2例：24.0比103.0 μmol/L，38.0比142.0 μmol/L）提示肺、肝、肾功能明显改善。CVVHDF作为一种辅助治疗方法可迅速降低KD合并MODS患儿的IL-6和TNF-α水平，并改善其器官功能。
