[Analysis of the current application status of blood purification therapy in critically ill children].

内容摘要

To analyze the clinical features, treatment mode selection, factors influencing prognosis and current clinical application of continuous blood purification (CBP) in critically ill children in a tertiary hospital in the Ningbo region, and provide evidence for optimizing critical care strategies for pediatric patients. A retrospective cohort study was conducted, enrolling 395 critically ill children who underwent CBP treatment at the Women and Children's Hospital of Ningbo University from January 2017 to December 2024. Clinical data of the children were collected and analyzed, including general demographic characteristics, distribution of primary diseases, CBP treatment-related parameters (including vascular access, anticoagulation method, and treatment mode), and prognosis. The children were divided into the survival group and the non-survival group according to their prognosis, and further stratified into the 2017-2020 group and the 2021-2024 group based on the treatment period. Clinical characteristics, intervention measures, and prognosis-related indicators were compared among different groups to explore the temporal trends in CBP application and the influencing factors of prognosis. A total of 395 children were enrolled, including 219 males and 176 females. The median age was 78 (24, 157) months, and the median body weight was 18 (12, 40) kg. Among them, 305 cases survived and 90 cases died, with a mortality of 22.8%. According to the treatment period, 134 cases were assigned to the 2017-2020 group and 261 cases to the 2021-2024 group. The main primary diseases were sepsis [27.1% (107/395)], renal failure [25.3% (100/395)], and acute poisoning [24.1% (95/395)] in order of frequency. The predominant CBP treatment mode was continuous veno-venous hemodiafiltration [CVVHDF; 60.8% (240/395), followed by hemoperfusion [HP; 15.7% (62/395)], therapeutic plasma exchange [TPE; 9.1% (36/395)], and hybrid blood purification treatment [HBPT; 14.4% (57/395)]. The right internal jugular vein was the main vascular access [51.1% (202/395)], and systemic heparin anticoagulation was the primary anticoagulation method [93.7% (370/395)]. The overall incidence of complications was 15.2% (60/395), mainly including thrombocytopenia and catheter-related infection. Compared with the survival group, the non-survival group had significantly younger age [months: 38.0 (6.0, 72.5) vs. 100.0 (30.0, 159.0)], lower body weight [kg: 12.3 (7.0, 20.0) vs. 22.5 (13.0, 43.0)], higher proportions of combined multiple organ dysfunction syndrome [MODS; 95.6% (86/90) vs. 22.0% (67/305)], use of vasoactive drugs [92.2% (83/90) vs. 20.3% (62/305)], mechanical ventilation [100% (90/90) vs. 40.7% (124/305)], and extracorporeal membrane oxygenation (ECMO) support [5.6% (5/90) vs. 0.7% (2/305)], as well as shorter hospital stay [days: 9.0 (3.8, 16.3) vs. 15.0 (9.0, 26.0)], all P<0.05. Additionally, the non-survival group had higher proportions of primary diseases including necrotizing encephalopathy, hypernatremia, hemophagocytic syndrome, and post-congenital heart disease surgery (all P<0.05). Compared with the 2017-2020 group, the 2021-2024 group showed significantly increased age [months: 102.0 (28.0, 160.5) vs. 42.0 (17.0, 102.0)] and body weight [kg: 18.5 (13.0, 45.0) vs. 15.0 (11.0, 29.0)], decreased overall mortality rate [18.8% (49/261) vs. 30.6% (41/134)], higher proportion of right internal jugular vein as vascular access, increased ratio of regional citrate anticoagulation [5.7% (15/261) vs. 0.7% (1/134)], reduced proportion of combined MODS [33.0% (86/261) vs. 50.0% (67/134)], elevated rate of ECMO support [2.7% (7/261) vs. 0% (0/134)], and shortened hospital stay [days: 11.0 (6.0, 21.0) vs. 17.0 (12.0, 34.0)], all P<0.05. Moreover, the 2021-2024 group had a lower proportion of sepsis and a higher proportion of renal failure among primary diseases (both P<0.05). CBP represents a valuable therapeutic modality for critically ill children. Its efficacy is closely linked to patient age, the underlying disease, and the extent of organ support required. Optimizing anticoagulation strategies, improving vascular access selection, and implementing early intervention hold promise for further reducing mortality and improving prognosis.