摘要目的:探讨高压氧联合高容量血液滤过（HVHF）对脓毒症心肌损伤患儿心肌损伤指标及血管内皮功能的影响。方法:选取2017年1月至2020年12月山西省儿童医院儿童重症医学科收治的脓毒症心肌损伤患儿96例作为研究对象，按照随机数字表法分为对照组与观察组，每组48例。入院后均予以对症治疗，对照组予以常规吸氧联合HVHF治疗，观察组在对照组治疗的基础上予以高压氧辅助治疗。采用ELISA法测定2组患儿治疗前后的肌钙蛋白（cTn I）、肌酸激酶-MB（CK-MB）、B型钠尿肽（BNP）、内皮素-1（ET-1）、血管性假血友病因子（vWF）、一氧化氮（NO）、白细胞介素（IL）-6、IL-10、γ干扰素（IFN-γ）及T淋巴细胞亚群指标水平。采用儿科危重症评分标准（PCIS）评估患儿病情的严重程度。结果:观察组治疗后血清CK-MB、BNP、cTn I水平明显低于对照组（ P<0.05或 P<0.01）；血清ET-1、vWF水平低于对照组，NO水平高于对照组（ P<0.05或 P<0.01）；血清IL-6、IFN-γ、CD 8+水平低于对照组，IL-10、CD 3+、CD 4+、CD 4+/CD 8+水平高于对照组（ P<0.05或 P<0.01）。2组患儿治疗后PCIS均升高，观察组明显高于对照组（ P<0.05或 P<0.01）。 结论:高压氧联合HVHF对脓毒症心肌损伤患儿具有较好临床疗效，可显著改善患儿的免疫功能，降低心肌损伤程度，从而改善患儿的血管内皮功能。

abstractsObjective:To investigate the effect of hyperbaric oxygen combined with high volume hemofiltration（HVHF）on myocardial injury indexes and vascular endothelial function in children with sepsis myocardial injury.Methods:A total of 96 patients with sepsis myocardial injury admitted to Shanxi Children’s Hospital from January 2017 to December 2020 were selected and randomly divided into control group and observation group according to the random number table method，with 48 cases each. After admission，all patients were given basic symptomatic treatment，of which the control group was given conventional oxygen inhalation + HVHF treatment，and the observation group was additionally given hyperbaric oxygen adjuvant therapy. The levels of cTn I，CK-MB，BNP，ET-1，vWF，NO，IL-6，IL-10，IFN-γ，and T lymphocyte subsets before and after treatment were measured by ELISA method. The severity of the patients’ condition was evaluated by the pediatric critical illness score（PCIS）.Results:After treatment，the levels of CK-MB，BNP，and cTn I in the observation group were significantly lower than those in the control group（ P<0.05 or P<0.01）. After treatment，the levels of serum ET-1 and vWF in the observation group were lower than those in the control group，while the levels of NO were higher than those in the control group（ P<0.05 or P<0.01）. The serum levels of IL-6，IFN-γ，and CD 8+ in the observation group were lower than those in the control group，while the levels of IL-10，CD 3+，CD 4+，and CD 4+/CD 8+ in the observation group were higher than those in the control group（ P<0.05 or P<0.01）. After treatment，PCIS scores in both groups increased，and the score of the observation group was significantly higher than that of the control group（ P<0.05 or P<0.01）. Conclusion:Hyperbaric oxygen combined with HVHF has a good clinical effect on treating sepsis myocardial injury. It is of great value for significantly improving patients’ immune function，reducing the degree of myocardial injury，thereby improving patients’ vascular endothelial function.