Ning Botao, Ye Sheng, Lyu Yi, Yin Fan, Chen Zhenjie
Pediatric Intensive Care Unit, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
Pediatric Intensive Care Unit, the Children's Hospital of Zhejiang University, School of Medicine, Shanghai 310052, China.
Transl Pediatr. 2020 Apr;9(2):101-107. doi: 10.21037/tp.2020.03.13.
Sepsis has always been a challenge in pediatric intensive care unit (PICU) with poor prognosis. In order to evaluate the effect between routine continuous renal replacement therapy (CRRT) and high-volume hemofiltration (HVHF) in children with sepsis, we performed out this prospective, randomized, controlled, open-label trial.
Forty-seven children with sepsis were enrolled from January 2015 to December 2016. Twenty-two patients in Control group received routine CRRT and 25 patients in HVHF group received HVHF within 6 hours after the diagnosis of sepsis. The oxygenation index, serum creatinine, urea, lactate, inflammatory cytokines (IL-6, IL-10, and TNF-α), pediatric risk of mortality III (PRISM III) and 28-day mortality rate were collected and compared.
The oxygenation index in HVHF group and Control group was significantly increased at 48 hours (P<0.01) and 72 hours after treatment (P<0.05). The same result of arterial lactate was observed. Serum creatinine, urea, IL-6, IL-10, TNF-α and PRISM III score were significantly ameliorated after 72 hours treatment in HVHF group (P<0.01), while there was no significant difference in Control group. After 72 hours of treatment, the oxygenation index, lactate, serum creatinine, urea, TNF-α, IL-6, IL-10 and PRISM III score in HVHF group were significantly improved compared with Control group (P<0.01). There is no significant difference on 28-day mortality between the two groups (P>0.05).
HVHF might be an effective treatment for children with sepsis.
脓毒症一直是儿科重症监护病房（PICU）面临的挑战，预后较差。为了评估常规连续性肾脏替代疗法（CRRT）与高容量血液滤过（HVHF）对脓毒症患儿的治疗效果，我们开展了这项前瞻性、随机、对照、开放标签试验。
2015年1月至2016年12月纳入47例脓毒症患儿。对照组22例患者接受常规CRRT，HVHF组25例患者在脓毒症诊断后6小时内接受HVHF。收集并比较氧合指数、血清肌酐、尿素、乳酸、炎性细胞因子（IL-6、IL-10和TNF-α）、儿科死亡风险Ⅲ（PRISMⅢ）及28天死亡率。
治疗后48小时（P<0.01）及72小时（P<0.05），HVHF组和对照组的氧合指数均显著升高。动脉血乳酸也有同样结果。HVHF组治疗72小时后血清肌酐、尿素、IL-6、IL-10、TNF-α及PRISMⅢ评分显著改善（P<0.01），而对照组无显著差异。治疗72小时后，HVHF组的氧合指数、乳酸、血清肌酐、尿素、TNF-α、IL-6、IL-10及PRISMⅢ评分与对照组相比显著改善（P<0.01）。两组28天死亡率无显著差异（P>0.05）。
HVHF可能是治疗脓毒症患儿的有效方法。
