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目的探讨连续性静-静脉血液透析/滤过(CVVHDF)对小儿急性肝功能衰竭的治疗作用。方法 2009年5月至2010年5月期间,采用CVVHDF辅助治疗上海交通大学附属儿童医院重症监护病房(PICU)收治的急性肝功能衰竭患儿共5例。其中男2例,女3例。年龄10个月至5岁。入院时发病时间3～14d。药物性肝损(对乙酰氨基酚)3例,严重脓毒症合并肝损1例,阑尾炎术后门静脉炎引起的肝损1例。肝性脑病分级:2级1例,3级2例,4级2例。观察治疗前后病情及肝功能指标,并观察处理并发症。结果 CVVHDF治疗开始时间为入院后(2～24h),治疗时间为(24～144h),5例患儿中治愈3例,自动出院1例,死亡1例。CVVHDF治疗后12h,丙氨酸转氨酶(ALT)从(3888.76±2373.60)U/L下降至(3284.80±1974.80)U/L,治疗后24～48h继续下降,差异有统计学意义(F=3.58,P<0.05);CVVHDF治疗后12h,血氨从(209.00±53.61)μmol/L下降至(158.80±60.93)μmol/L,差异有统计学意义,以后继续好转(F=3.75,P<0.05)。CVVHDF治疗后12～48h,总胆红素虽有下降,但差异无统计学意义(F=0.23,P>0.05)。CVVHDF24h后,2例患儿肝性脑病分级从4级转为2级;CVVHDF48h后,1例患儿肝性脑病从3级转为2级。CVVHDF治疗过程中无低血容量性休克发生。结论 CVVHDF治疗肝功能衰竭,能够改善临床症状和肝功能、降低血氨水平,是儿童肝功能衰竭的救治手段之一。
Objective To investigate the therapeutic effect of continuous intravenous hemodialysis / filtration (CVVHDF) on acute liver failure in children. Methods From May 2009 to May 2010, a total of 5 children with acute liver failure admitted to Shanghai Jiaotong University affiliated children’s hospital intensive care unit (PICU) were treated with CVVHDF. There were 2 males and 3 females. Ages 10 months to 5 years. Onset time of onset 3 ~ 14d. 3 cases of drug-induced liver damage (acetaminophen), 1 case of severe sepsis with liver damage, 1 case of liver damage caused by portal phlebitis after appendicitis. Hepatic encephalopathy grade: 1 in 2 cases, 3 cases in 2 cases, 4 cases in 2 cases. Observed before and after treatment of disease and liver function indicators, and observe the treatment of complications. Results The time of CVVHDF treatment was 2 to 24 hours after admission, the treatment time was 24 to 144 hours, 3 cases were cured in 5 cases, 1 was discharged automatically and 1 died. ALT decreased from (3888.76 ± 2373.60) U / L to (3284.80 ± 1974.80) U / L at 12h after CVVHDF treatment, and continued to decrease 24 to 48 hours after treatment (F = 3.58, P <0.05). After 12 hours CVVHDF treatment, blood ammonia decreased from (209.00 ± 53.61) μmol / L to (158.80 ± 60.93) μmol / L and the difference was statistically significant and continued to improve afterwards (F = 3.75, . Although the total bilirubin decreased from 12 to 48 hours after CVVHDF treatment, the difference was not statistically significant (F = 0.23, P> 0.05). After CVVHDF24h, the grade of hepatic encephalopathy was changed from grade 4 to grade 2 in 2 children. After 48 hours of CVVHDF, one patient had hepatic encephalopathy from grade 3 to grade 2. Hypovolemic shock does not occur during CVVHDF treatment. Conclusion CVVHDF treatment of liver failure, can improve clinical symptoms and liver function, reduce blood ammonia levels, is one of the means of treatment of children with liver failure.