Objective:To explore the role of continuous renal replacement therapy (CRRT) combined with extracorporeal carbon dioxide removal (ECCO 2R) in the treatment of children with respiratory failure. Methods:The clinical data of 12 children with respiratory failure who were treated with CRRT+ECCO 2R in PICU of Jinan Children's Hospital from July 2020 to August 2022 were collected and analyzed retrospectively. The outcomes and the external pipeline usage of the patients were observed, and the blood gas analysis and ventilator parameters before 1 h and after 1, 6, 12 and 24 h of the treatment were compared by one-way ANOVA with LSD post hoc correction. Results:Six patients successfully withdrew from CRRT+ECCO 2R and mechanical ventilation, three patients were transferred to ECMO treatment. Three cases died after voluntary withdrawal of treatment, and two cases died due to treatment failure. The mortality rate was 41.7%. After continuous treatment of CRRT+ECCO 2R for 15 to 112 h, two cases experienced extracorporeal circuit obstruction. After 1 h of treatment, PaCO 2 decreased from (64.67±24.4) mmHg to (49.42±15.54) mmHg, pH increased from (7.28±0.20) to (7.38±0.11), FiO 2 decreased from (0.85±0.13) to (0.78±0.15), PC decreased from (19.42±4.34) cmH 2O to (17.75±4.00) cmH 2O. After 24 h of treatment, PaCO 2 decreased to (39.2±5.55) mmHg, pH increased to (7.41±0.04), FiO 2 decreased to (0.46±0.11), and PC decreased to (13.8±3.36) cmH 2O, and the differences were statistically significant compared with before treatment ( P < 0.05). Conclusions:The combination of CRRT and ECCO 2R therapy can safely substitute for partial lung ventilation/perfusion function, and play a role in protecting right heart function and improving lung-kidney interaction. It can be considered as an option for extracorporeal respiratory, circulatory, and renal support, and consequently has broad prospects.
目的 总结儿童斯-琼综合征的临床特点、救治经验，以提高对此病的认识与诊治水平。 方法 回顾性分析2014年1月至2016年5月山东大学齐鲁儿童医院PICU收治的13例斯-琼综合征患儿的临床资料。 结果 13例患儿中，男8例，女5例，年龄6个月～11岁。引发斯-琼综合征的原因包括8例与药物有关，其中5例为头孢类抗生素，2例为卡马西平，1例为阿司匹林；3例为肺炎支原体感染；2例原因不明。所有患儿均有全身分布的红色斑丘疹，继而出现大疱、皮肤剥脱，伴明显的口唇、口腔黏膜及眼结膜损害。皮肤剥脱面积大于30%者8例，其中反复皮肤剥脱者2例。8例男童同时有外生殖器黏膜受累。1例患儿除皮肤剥脱外，还伴有指甲的剥脱。所有患儿入院后均给予大剂量丙种球蛋白及甲泼尼龙治疗，并给予血浆置换治疗及严格的皮肤护理。治愈10例，死亡3例。 结论 斯-琼综合征以药物引起的最多见，尤其抗生素及含苯环的抗癫痫药物，肺炎支原体感染也应关注。血浆置换治疗斯-琼综合征的作用是肯定的，且应用越早效果越好。精心的皮肤护理是治疗成功不可忽视的重要环节。
目的：分析肠道病毒71型（简称EV71型）危重症手足口病患儿的临床特点，为该病的诊断及治疗提供依据。方法回顾性分析187例EV71型危重症手足口病患儿的临床资料，分析临床表现、实验室检查、影像学检查、治疗方法等资料。结果187例患儿早期临床症状表现为持续高热、精神萎靡、肢体抖动、眼球震颤等，均伴有神经系统症状。脑脊液压力增大者占50．80％。145例行颅脑MRI 检查，示脑干损伤者占31．72％、脑水肿者占43．45％、大脑白质脱髓鞘病变者占7．59％。入院后给予退热、镇静、大剂量维生素C、磷酸肌酸、胃黏膜保护剂等对症治疗，针对病情危重程度给予限制入量、降低颅内压、应用糖皮质激素、静脉注射丙种免疫球蛋白、拮抗交感神经兴奋性等治疗。187例患儿治疗10～57 d、平均13．5 d。其中死亡12例，转康复科康复治疗9例，其余均临床治愈出院。结论 EV71型危重症手足口病患儿易出现神经系统受累，颅脑MRI检查有助于诊断及病情判断，早期诊断和及时干预是有效手段。
