高容量血液滤过治疗多器官功能障碍综合征的分析  

High volume hemofiltration therapy in patients with multiple organ dysfunction syndrome

作　　者：于凯江[1] 赵鸣雁[1] 高岩[1] 刘丽敏[1] 王洪亮[1] 费东升[1] 

机构地区：[1]哈尔滨医科大学附属第一医院ICU,150001

出　　处：《中华普通外科杂志》2004年第9期528-530,共3页Chinese Journal of General Surgery

摘　　要：目的研究高容量血液滤过 (HVHF)在多器官功能障碍综合征 (MODS)治疗中的作用。方法 19例MODS患者 ,随机选择 10例行HVHF ,另 9例行常规连续性静脉 静脉血液滤过 (CVVH)。于治疗前和治疗开始后 2、4、8h动脉采血 ,检测血气、血肌酐 (Scr)、尿素氮 (BUN)、肿瘤坏死因子(TNFα)、白细胞介素 1(IL 1β)、白细胞介素 6 (IL 6 )的变化。 结果HVHF组与CVVH组于治疗开始后4h血Scr、BUN均显著下降 ,肾功能改善。HVHF组血TNFα、IL 1β、IL 6治疗前分别为 ( 1795± 5 0 6 )ng/L、( 96 4± 185 )ng/L、( 1332± 4 15 )ng/L ,治疗开始后 4h为 ( 12 6 5± 397)ng/L、( 5 11± 12 4 )ng/L、( 72 6±2 4 3)ng/L ,差异有显著意义 ,P <0 0 5。CVVH组血TNFα治疗前为 ( 1799± 5 11)ng/L ,治疗开始后 4h为 ( 132 7± 4 2 1)ng/L ,差异有显著意义 ,P <0 0 5。HVHF组死亡 3例 ( 3/ 10 ) ,CVVH组死亡 5例 ( 5 / 9) ,差异有显著意义 ,P <0 0 5。结论HVHF可通过对流和AN6 9膜的吸附作用清除大量炎症介质 。Objective To study the effect of high volume hemofiltration(HVHF) in patients with multiple organ dysfunction syndrome (MODS). Methods Nineteen MODS patients were divided into two groups randomly, 10 patients receiving HVHF and 9 patients treated by routine continuous venovenous hemofiltration(CVVH).Artery blood was sampled before and 2、4、8 hours after HVHF and CVVH, concentrations of Scr, BUN, TNFα, IL 1β, IL 6 and blood gas were measured.Results In both HVHF group and CVVH group, the 4th hour Scr、BUN decreased significantly, renal function improved. In HVHF group compared with pre-treatment level the 4th hour concentrations of TNFα[(1 759±506)ng/L vs. (1 265±397)ng/L]、IL-1β[(964±185)ng/L vs. (511±124)ng/L]、IL-6[(1 332±415) ng/l vs. (726±243)ng/L] decreased singificantly. In CVVH group, the 4th hour concentrations of TNFα[(1 799±511) vs.(1 327±421) ng/L] decreased significantly (all P<0.05). The mortality of HVHF group was 30.0% (3/10) compared with 55.6% (5/9) in CVVH group, the difference was significant (P<0.05). Conclusion HVHF can eliminate proinflammatory mediators to improve the prognosis of MODS patients.

关 键 词：治疗前 CVVH 高容量血液滤过 多器官功能障碍综合征 MODS TNF 患者 BUN 死亡 

分 类 号：R459.7[医药卫生—急诊医学]