Clinical Study Of Continuous Renal Replacement Therapy For Severe Sepsis In Children

BackgroundSepsis is one of the main diseases threatening children’s life and health.It is a common cause of death in PICU children.According to Surviving Sepsis Campaign:International Guidelines for Management of Severe Sepsis and Septic shock 2012,sepsis is an infection present（suspicious or confirmed）with systemic manifestations of infection.Severe sepsis is defined as sepsis with organ dysfunction or tissue hypoperfusion.In the past,the treatment of sepsis was mainly treated with anti-infection,symptomatic（including fluid resuscitation,the application of vasoactive drugs,the protection of important organs,etc.）,supportive and other routine treatment,but these treatments are very limited.In recent years,with the development of severe medicine,continuous renal replacement therapy（CRRT）has begun to be used as assisted in the treatment of sepsis,but it is less used in children,and the efficacy literature is more controversial.This retrospective study to explore its clinical efficacy in the application of severe sepsis in children.ObjectiveTo explore the overall clinical effect of continuous renal replacement therapy for severe sepsis in children.MethodsThis was a retrospective study.Collection some children with severe sepsis in PICU in the the first affiliated hospital Sun Yat-sen university from January 2016 to December2018,according to inclusion and exclusion criteria,55 children join group.28 patients in the control group were treated with anti-infection,symptomatic and supportive treatment,while the other 27 patients in the treatment group were treated with CRRT on the basis of conventional treatment.To study the general treatment and prognosis of the two groups（24-hour effective rate of initial treatmen,PICU hospitalization days,28-day case fatality rate）and 72 hours after the two groups of children into the group treatment,before and after treatment,general item T,HR,R,MAP;inflammatory indicators PCT,CRP;organ function indicators CK-MB,TnT,UREA,Cr,ALT、TIBL;internal environmental indicators K⁺,Na⁺,blood lactic acid,CO₂CP,AG;blood sugar numerical results,analysis,evaluation of the efficacy.SPSS 20.0 software was used for data analysis.Results1.There was no statistical difference between the control group and the treatment group before treatment,two groups had comparability.2.General treatment and prognosis:24-hour effective rate of initial treatment in two groups,the treatment group was significantly higher than the control group（P<0.05）;the number of days in PICU,the treatment group was significantly less than the control group（P<0.05）;28-day case fatality rate was compared between the two groups（P>0.05）,there was no statistical difference.3.Vital signs:T,HR,R,MAP:T,HR,R in control group was significantly lower than before treatment（P<0.05）,MAP was P>0.05,no statistical difference;the T,HR,R,MAP in treatment group compared before and after treatment,P<0.05,T、HR、R significantly lower than before treatment,and MAP significantly higher than before treatment.The comparison between the two groups after T、HR、R、MAP treatment,P<0.05,the T,HR,R of the treatment group was significantly lower than that of the control group,and the MAP was significantly higher than that of the control group.4.Inflammatory indicators:PCT,CRP:the control group was significantly lower than before treatment（P<0.05）.The PCT,CRP after treatment in the treatment group was significantly lower than before treatment（P<0.05）.The comparison between the two groups after treatment,PCT and CRP were significantly lower in the treatment group than in the control group（P<0.05）.5.Organ function:（1）CK-MB,TnT:the control group was significantly lower after treatment than before treatment（P<0.05）,and the treatment group was significantly lower after treatment than before treatment（P<0.05）.Compared with the two groups after CK-MB,TnT treatment,the treatment group was significantly lower the control group（P<0.05）.（2）UREA,Cr:control group compared before and after treatment,P>0.05,there is no statistical difference;the treatment group after treatment was significantly lower than before treatment（P<0.05）.Compared with the two groups after UREA,Cr treatment,the treatment group was significantly lower the control group（P<0.05）.（3）ALT,TBIL:comparison of control group before and after treatment,P>0.05,there is no statistical difference;comparison of treatment group before and after treatment,P>0.05,there is no statistical difference.Comparison of the two groups after ALT、TBIL treatment,P>0.05,there is no statistical difference.6.Internal environment:K⁺,Na⁺,blood lactic acid,CO₂CP,AG,blood glucose:K⁺,Na⁺,blood lactic acid,CO₂CP,AG and blood glucose comparison of control group before and after treatment,P>0.05,there is no statistical difference.The treatment group was significantly lower than before treatment after K⁺,Na⁺,blood lactic acid,AG treatment（P<0.05）,the CO₂CP was significantly higher than before treatment（P<0.05）,and there was no statistical difference before and after blood glucose treatment（P<0.05）.The K⁺,Na⁺,blood lactic acid,AG of the treatment group was significantly lower than that of the control group after two groups treatment（P<0.05）,the CO₂CP was significantly higher than the control group after two groups treatment（P<0.05）,and there was no significant difference in blood glucose between the two groups after treatment（P>0.05）.ConclusionContinuous renal replacement therapy for severe sepsis in children can rapidly improve the initial 24-hour condition,general items temperature,heart rate,respiratory rate,and mean arterial pressure,inflammatory reaction degree,heart function,kidney function and electrolyte acid-base balance disorder.It can shorten the PICU hospitalization days,but can not reduce the 28-day case fatality rate.