连续性静脉血液透析在创伤后多器官功能障碍综合征患者中的应用及护理  

Application of CVVHDF in the treatment of MODS after trauma and nursing care

作　　者：赵敏[1] 

机构地区：[1]枣庄市立医院,山东枣庄277100

出　　处：《齐鲁护理杂志》2009年第9期3-5,共3页Journal of Qilu Nursing

摘　　要：目的:探讨连续性静脉-静脉血液透析滤过(CVVHDF)治疗严重创伤后并发多器官功能障碍综合征(MODS)患者的疗效。方法:对因严重创伤入院接受加强治疗过程中并发MODS的29例患者行CVVHDF治疗。观察CVVHDF对患者的心率、平均动脉压、动脉血氧分压、血清尿素氮、肌酐、钾和预后情况的影响。结果:2例治愈,占6.89%;好转19例,占65.52%;死亡8例,占27.58%,分别在CVVHDF治疗后46、59、65、72、83、90、98、105 h死亡。29例患者在CVVHDF治疗0.5 h后,动脉压为(78.1±5.8)mm Hg(1 mm Hg=0.133 kPa),与治疗前(62.8±6.2)mmHg比较,差异有显著性意义(P<0.05);心率则显著减慢(P<0.05);动脉氧分压显著升高(P<0.05)。CVVHDF治疗8 h后,血清尿素氮、肌酐、钾与治疗前比较显著降低(P<0.05)。结论:CVVHDF是治疗严重创伤后并发MODS的有效手段。对创伤后MODS患者在采取常规治疗基础上进行CVVHDF治疗,做到细致、认真的观察和护理;缓慢、均匀的超滤;及时、及早的治疗是降低病死率的保障。Objective: To explore the effect of continuous venovenous hemodiafiltration(CVVHDF) in the treatment of severe post-traumatic multiple organ dysfunction syndrome(MODS).Methods: CVVHDF was applied to 29 patients admitted with MODS after severe trauma and the observation was made on the impact of CVVHDF on patients’ heart rate,mean arterial pressure,blood PaO2,blood urea nitrogen,creatinine,potassium and the prognosis.Results: Two patients were cured,accounting for 6.89%;19 patients improved,65.52%;8 patients died(31.03%) 46,59,65,72,83,90,98,105 hrs.after treatment respectively.In 29 patients treated with CVVHDF,the significant difference was found in the comparison of arterial pressure(78.1±5.8) mm Hg(1 mm Hg = 0.133 kPa) after treatment for 0.5 h with(62.8±6.2) mm Hg before treatment(P<0.05);heart rate slowed significantly(P<0.05);blood PaO2 increased significantly(P<0.05);serum urea nitrogen,creatinine and potassium significantly reduced after treatment for 8 hours compared with that before treatment(P<0.05).Conclusions: CVVHDF is an effective therapeutic method in the treatment of severe post-traumatic MODS.Careful observation and nursing care,slow and well-proportioned ultrafiltration,prompt and timely treatment during the course of CVVHDF can effectively reduce the mortality.

关 键 词：急性肾功能衰竭 多器官功能障碍综合征 连续性静脉-静脉血液透析滤过 护理 

分 类 号：R473.6[医药卫生—护理学]