连续性血液滤过治疗复苏后脑水肿的作用探讨  

Effects of Continuous Hemofiltration on Cerebral Edema Following Resuscitation

作　　者：黄东健[1] 徐如祥[2] 瞿文军[2] 唐新兴[1] 徐仲[1] 陈次滨[1] 

机构地区：[1]广州医学院附属市二人民医院,广州510150 [2]第一军医大学珠江医院

出　　处：《内科急危重症杂志》2004年第3期146-149,共4页Journal of Critical Care In Internal Medicine

基　　金：广东省医学科研立项资助课题 (项目编号 :A2 0 0 2 5 89)

摘　　要：目的 :探讨连续性血液滤过 (CHF)治疗心肺复苏后对血液动力学不稳定的脑水肿患者的疗效。方法 :2 4例行心肺复苏后出现脑水肿患者 ,格拉斯哥昏迷评分 (GCS) 5～ 6分 ,同时存在低血压 ,但不合并肾功能衰竭患者分为两组 :治疗组 11例 ,行CHF ;对照组 13例 ,按常规治疗。观测生命体征、GCS、乳酸和细胞因子水平等变化 ,3个月后行格拉斯哥预后评分 (GOS)评估预后。结果 :治疗组在行CHF治疗期间均无死亡 ,与对照组比较 ,治疗后 4h血压开始显著上升 ,多巴胺输注速度减少 ,血气分析 pH、HCO3 -、PCO2 维持在正常范围 ,氧合指数 (PO2 /FiO2 )显著上升 ,血清乳酸、IL 1β、IL6、TNF α水平显著下降。 3个月后GOS评估 ,治疗组优于对照组 ,GOS 4～ 5级者治疗组 7例 (7/11,6 3.6 % )vs对照组 1例 (1/13,7.7% ) ,P <0 .0 1;病死率 :治疗组 2例 (2 /11,18.2 % )vs对照组 8例 (8/13,6 1.5 % ) ,P <0 .0 5。结论 :CHF能较好地改善心肺复苏后的血流动力学 ,稳定内环境 ,清除体内细胞因子和乳酸等炎性介质 ,从而减轻脑再灌注损伤 ,对复苏后脑水肿治疗有利 。Objective: To investigate the effect of continuous hemofiltration (CHF) on outcome of cerebral edema with unstable hemodynamics following cardio-pulmonary resuscitation. Methods: Twenty-four inpatients with cerebral edema glasgow coma scale (GCS) 5-6 after cardio-pulmonary resuscitation and accompanied with hypotension were divided into two groups: The study group (n=11) underwent continuous hemofiltration(CHF). The control group (n=13) recieved conventional methods. During the treatment, vital signs were continuously monitored, GCS, lactic acid, cytokine in plasma were measured. Glasgow Outcome Scale(GOS)was evaluated after 3 months. Results: None died during the course in the study group. Compared with the control group, there was a significant increase in arterial pressure and a decrese of infusion rate of vasoactive drugs after 4 hours' treatment. Blood pH、HCO_3^-、PCO_2 were maintained in the normal range, while a significant increase in PO_2/FiO_2 and a decrease in plasma lactic acid, IL-1β, IL6, TNF-α were found. After 3 months, according to GOS, the outcome of the study group was improved, GOS 4-5 (7/11,(63.6%) vs 1/13,(7.7%));mortality rate(2/11,(18.2%) vs 8/13,(61.5%)). Conclusions: Continuous hemofiltration can improve hemodynamics after pulmonary resuscitation,and stabilized internal environment, enhanced clearance of cytokines, it's an effective treatment for brain reperfusion injury.

关 键 词：连续性血液滤过 复苏后脑水肿 脑再灌注损伤 预后 

分 类 号：R459.5[医药卫生—治疗学]