探讨血液净化对儿童多器官功能障碍综合征(MODS)的临床疗效。

选择2007年1月至2011年7月四川大学华西第二医院收治的194例MODS住院患儿为研究对象。按照不同治疗方案，将其分为血液净化组(n＝96)和非血液净化组(n＝98)。比较两组患儿的一般情况(性别构成比、年龄分布、原发病病因及主要损伤脏器等)，病死率，住院时间，入院至死亡时间，治疗前及治疗后的主要生化指标[血清肌酐、尿素氮、天冬氨酸转氨酶(AST)、心肌肌钙蛋白(cTn)I、Na^＋、K^＋、动脉血氧分压(PaO₂)/吸入氧气分数(FiO₂)]等。两组患儿的性别构成比、主要损伤脏器小儿logistic器官功能障碍(PELOD)评分等比较，差异无统计学意义(P>0.05)。本研究遵循的程序符合四川大学华西第二医院人体试验委员会制定的伦理学标准，得到该委员会批准。

①两组患儿性别构成比比较，差异无统计学意义(χ²＝0.495，P＝0.482)，而年龄分布比较，差异有统计学意义(χ²＝54.069，P＝0.000)；两组患儿主要损伤脏器PELOD评分比较(10分vs 10分)，差异无统计学意义(Z＝－1.291，P＝0.197)。②血液净化组患儿病死率显著低于非血液净化组(20.8% vs 42.9%)，并且差异有统计学意义(χ²＝10.56，P＝0.002)；两组患儿住院时间比较(10 d vs 12 d)，差异无统计学意义(Z＝－1.203，P>0.229)；血液净化组患儿入院至死亡时间显著短于非血液净化组(8.0 d vs 17.0 d)，并且差异有统计学意义(Z＝－2.007，P＝0.045)。③血液净化组患儿经治疗后肌酐、尿素氮及Na^＋水平改善程度均显著好于非血液净化组，并且差异有统计学意义(Z＝－2.325，－2.498，－3.179；P<0.05)；两组患儿治疗后AST、cTnI、K^＋和PaO₂ / FiO₂水平比较，差异无统计学意义(P>0.05)。

血液净化可明显降低MODS患儿病死率，并可促进患儿肾功能改善。

To evaluate clinical effects of blood purification in the treatment of children with multiple organ dysfunction syndrome (MODS).

A total of 194 cases with MODS who were admitted to West China Second University Hospital, Sichuan University from January 2007 to July 2011 were retrospectively reviewed. According to different treatment regimen, they were divided into treatment group (n=96, basic treatment+ blood purification) and control group (n=98, only basic treatment). Compare the following parameters between two groups: gender constituent ratio, age, basic diseases, pediatric logistic organ dysfunction (PELOD) score, mortality, hospitalization and results of major biochemical tests [serum creatinine, blood urea nitrogen, aspartate aminotransferase (AST), cardiac troponin(cTn)I, Na⁺ , K⁺ , partial pressure of oxygen in artery (PaO₂) / fraction of inspired oxygen (FiO₂)] before and after the treatment. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital, Sichuan University.

① There were no significant difference between two groups in the aspects of gender constituent ratio (χ²=0.495, P=0.482), but there were significant differences in age, PELOD score of impaired organs (χ²=54.069, P=0.000, Z=-1.291, P=0.197). ②The mortality of treatment group was significantly lower than that in control group (20.8% vs 42.9%)(χ²=10.56, P=0.002). There was no significant difference between two groups in hospitalization (Z=-1.203, P=0.229). And duration from admission to death was 8.0 days in treatment group and 17.0 days in control group with significant difference (Z=-2.007, P=0.045). ③ There were significant differences between two groups in the aspects of levels of creatinine, BUN, and Na⁺ after the treatment (Z=-2.325, -2.498, -3.179; P<0.05), and there were no significant differences between two groups in the aspects of AST, cTnI, K⁺ and PaO₂/FiO₂(Z=-1.570, -0.632, -0.999, -0.016; P>0.05).

Blood purification could decrease the mortality of children with MODS significantly and improve their renal function.