Discussion on the timing of plasma exchange combined with continuous veno-venous hemodiafiltration in children with Kawasaki disease shock syndrome
10.3760/cma.j.issn.1673-4912.2025.07.007
- VernacularTitle:血浆置换联合连续性静-静脉血液透析滤过治疗在儿童川崎病休克综合征应用时机的探讨
- Author:
Xiayan KANG
1
;
Xinping ZHANG
;
Yuanhong YUAN
;
Zhiyue XU
;
Jianghua FAN
;
Zhenghui XIAO
Author Information
1. 湖南省儿童医院重症医学科，长沙 410007
- Publication Type:Journal Article
- Keywords:
Plasma exchange;
Continuous veno-venous hemodiafiltration;
Kawasaki disease shock syndrome;
Children
- From:
Chinese Pediatric Emergency Medicine
2025;32(7):514-518
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the clinical effects of plasma exchange（PE）combined with continuous veno-venous hemodiafiltration（CVVHDF）at different time points in children with Kawasaki disease shock syndrome（KDSS）.Methods:Thirty-five children with KDSS admitted to the intensive care unit of Hunan Children's Hospital from January 2018 to December 2022 were enrolled.According to whether PE combined with CVVHDF was performed within 24 hours after reaching the blood purification criteria for KDSS，the patients were divided into the early treatment group(8 cases) and the control group (27 cases).The clinical and laboratory indicators and prognosis were compared between the two groups.Results:There were no statistically significant differences in age，gender，mean arterial pressure，and pediatric critical illness score between the two groups before treatment（ P>0.05）.In the early treatment group,the vasoactive inotropic score (VIS) gradually decreased,and was significantly lower than that in the control group after 24 hours of treatment.The duration of vasopressor use，pediatric logistic organ dysfunction score（PELOD），inflammatory markers，total hospitalization time，and PICU stay were all lower in the early treatment group than in the control group（ P<0.05）.The incidence of coronary artery involvement within 6 months post-discharge was lower in the early treatment group than in the control group（ P<0.05）.Among the 12 children who underwent PE combined with CVVHDF，four cases were in the late treatment group.The duration of CVVHDF，PICU stay，and PELOD scores were lower in the early treatment group than in the late treatment group（ P<0.05）.Additionally，the concentrations of interleukin-6，tumor necrosis factor-α，heparin-binding protein，and N-terminal pro-brain natriuretic peptide before PE were lower in the early treatment group than in the late treatment group（ P<0.05）. Conclusion:Early PE combined with CVVHDF treatment for KDSS patients can reduce inflammatory response，shorten the course of the disease，and reduce the duration of vasopressor use.However，most patients' conditions can be controlled with active conventional treatment.
