目的观察持续静脉-静脉血液滤过(continuous venous-venous hemofiltration，CVVH)治疗剂量对危重患儿预后的影响。方法回顾性纳入2010 年1 月～2015 年12 月期间广东省人民医院接受CVVH 治疗的危重患儿。比较CVVH 处方低剂量组[≤35ml/(kg·h)]及高剂量组[＞35ml/(kg·h)]间的预后。结果高剂量组和低剂量组30 天住院死亡率(38.5%比46.2%，χ2=0.265，P =0.607)、总住院时间[15(13,21) 比17(9,24)，Z=- 0.239，P =0.811] 及ICU 内住院时间[13(6,21) 比12(6,17)，Z=- 0.448, P =0.654]均无统计学差异。在Cox 回归中对其他危险因素校正后，高剂量组仍未能减少住院死亡(HR0.768,95% CI,0.261～2.264，P=0.632)。结论超过35ml/(kg·h)的CVVH 处方剂量未能改善危重患儿预后。

Objective The aim of this study is to evaluate the effect of different doses of continuous venovenous hemofiltration (CVVH) on outcome of critically ill children. Methods The clinical data of critically ill children treated with CVVH in the Pediatric Intensive Care Unit of Guangdong General Hospital between Jan. 2010 and Dec. 2015 were retrospectively analyzed. They were divided into two groups based on the prescribed effluent volume: lower dose group (prescribed effluent volume ≤35 ml/kg/h) and higher dose group (prescribed effluent volume ＞35ml/kg/h). The in-hospital outcomes including 30 days in-hospital mortality, lengths of stay in hospital and in ICU were compared between the two groups. Results A total of 39 critically ill children were enrolled in this study. The 28 days in-hospital mortality was 43.6%, and the median lengths of stay in hospital and in ICU were 16 (10,24) and 19 (12,30) days respectively. There were no significant differences in 30 days in-hospital mortality (38.5% vs. 46.2%, 0.265, P=0.607), lengths of stay in hospital [15 (13,21) vs. 17 (9,24), Z=-0.239, P=0.811] and in ICU [13 (6,21) vs. 12 (6,17), Z=-0.448, P= 0.654] between the two groups. Multivariate Cox’s proportional hazards regression found that the higher dose group was not associated with the lower risk of in-hospital death (HR=0.768; 95% CI 0.261～2.264, P=0.632). Conclusions Effluent volume ＞35ml/kg/h was not related to the better outcome in hospital. Therefore, the CVVH dose for critically ill children can follow the guideline for adults that recommends the practical effluent volume of 20～25 ml/(kg•h) or prescribed effluent volume of 30～35ml/(kg•h).