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中国循证儿科杂志

中国循证儿科杂志 ›› 2017, Vol. 12 ›› Issue (5): 347-351.

• 论著 • 上一篇    下一篇

连续血液净化技术在中国儿童重症医学科应用状况的横断面调查

杨雪1，钱素云2，祝益民3，许煊4，刘春峰5，许峰6，任晓旭7 ，王莹8 ，张育才9，陆国平1   

  • 收稿日期:2017-11-30 修回日期:2017-11-30 出版日期:2017-10-25 发布日期:2017-10-25
  • 通讯作者: 陆国平

The application status of continuous blood purification in Chinese pediatric critical care medicine: a cross-sectional survey

YANG Xue1， QIAN Su-yun2， ZHU Yi-min3， XU Xuan4， LIU Chun-feng5， XU Feng6， REN Xiao-xu7，WANG Ying8， ZHANG Yu-cai9， LU Guo-ping1   

  • Received:2017-11-30 Revised:2017-11-30 Online:2017-10-25 Published:2017-10-25
  • Contact: LU Guo-ping

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1016

摘要： 摘要目的：了解中国儿科血液净化技术2012年至2016年的发展情况。方法：采用横断面调查方案，选择中华医学会和中国医师协会儿科急救或重症学组成员单位为调查医院，基于2012年相同调查问卷修改完善《CBP应用现状调查表》（简称调查表），调查内容：①调查医院性质、规模和PICU床位数；②各项血液净化技术开展情况：腹膜透析（IPD）、血液透析（IHD）、连续肾脏替代治疗（CRRT）、血浆置换技术（TPE）、血液灌流（HP）、血液吸附（PA）和人工肝支持（ALSS）；③CBP救治病种及并发症的分布情况，对调查医院统一培训后完成填写。结果： 2016年12月30日至2017年3月30日28个省中39个城市53/55家医院完成调查表填写，儿科专科医院39家，综合性医院14家，三级甲等医院49家；均有PICU病房，PICU平均床位数25张。开展CRRT的23家医院共有6 618例；开展TPE的32家医院2 580例，开展HP的23家医院2 238例，开展ALSS的20家医院开展961例。应用各项技术的病例数呈逐年增加趋势，IPD所占比例呈下降趋势。CBP各技术的实施80%以上的医院以ICU为主，其次为肾内科；CBP主要应用于脓毒症24.3%，MODS 20.3%，药物中毒12.7%等的治疗。9家医院已开展新生儿CBP技术，共46例新生儿接受CBP治疗。5年间共有1 093例肝功能衰竭患儿应用CBP的治疗，各模式成活率 HP 85.7%，TPE+HP 72.0%，TPE 70.5%、CRRT 69.8%，TPE+CRRT模式50.0%。CBP的主要并发症为深静脉置管吸壁、堵膜等。结论：2012年至2016年CBP技术在全国儿童重症领域得到很大推广，尤其在脓毒症等疾病的应用方面。

Abstract: AbstractObjective：To study the application of continuous blood purification(CBP) in Chinese pediatric critical care medicine from 2012 to 2016. Methods：A questionnaire named Application Status of Continuous Blood Purification Technology in 2012 was revised and perfected according to a crosssectional study. The Chinese Medical Association and Chinese Medical Doctor Association pediatric emergency or critical care unit members were selected as the investigation hospital. The survey contents: ① the nature, size and number of PICU beds of investigative hospitals; ②the implementation of peritoneal dialysis (IPD), hemodialysis (IHD), continuous renal replacement therapy (CRRT), plasma exchange (TPE), hemoperfusion (HP), blood adsorption (PA) and artificial liver support (ALSS); ③ the application in different diseases and the complications of CBP. Participated hospitals received a unified training and then finished filling out the questionnaire. Results：From December 30, 2016 to March 30, 2017, 53/55 hospitals in 39 cities of 28 provinces completed filing out the questionnaires, among which there were 39 pediatric hospital, 14 general hospitals and 49 Thirdlevel gradeA hospitals. All the 53 hospitals had PICU wards, and the average bed number of PICU was 25. 23 hospitals carried out CRRT, with 6 618 cases; 32 hospitals carried out TPE with 2 580 cases; 23 hospitals carried out HP with 2 238 cases; 20 hospitals carried out ALSS with 961 cases. The number of cases using various blood purification techniques showed an increasing trend year by year, while the proportion of IPD showed a downward trend.The implementation of CBP was mainly in ICU in more than 80% hospitals, followed by nephrology. CBP is mainly used in the treatment of sepsis (24.3%), MODS (20.3%), drug poisoning (12.7%) and other diseases.Neonatal CBP has been carried out in 9 hospitals, and 46 neonates received CBP treatment.1 093 children with liver failure were treated with CBP; the survival rates of each model were HP 85.7%, TPE+HP 72%, TPE 70.5%, CRRT 69.8%, TPE+CRRT 50%. The leading complication of CBP included deep vein catheter suction, membrane occlusion and so on.Conclusion：CBP is rapidly popularized in pediatric critical care in China from 2012 to 2016 and widely used in the treatment of sepsis.