多脏器功能不全综合征的连续性血液净化治疗  

Treatment of abdominal surgical diseases associated with multiple organ dysfunction syndrome by continuous blood purification

作　　者：赵英萍[1] 李超[2] 姜松青[3] 熊旭明[4] 吴素红[5] 刘玉琪[1] 寇秋野[1] 梁细妹[1] 罗向明[1] 廖琼[6] 

机构地区：[1]江门市中心医院重症监护中心,广东江门529070 [2]江门市中心医院外科,广东江门529070 [3]江门市中心医院肾内科,广东江门529070 [4]广州医学院第二附属医院重症监护中心 [5]中山市人民医院肾内科 [6]江门市中心医院中心实验室,广东江门529070

出　　处：《中国基层医药》2004年第9期1093-1095,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的　探讨连续性血液净化 (ＣＢＰ)技术在腹部外科疾病合并多脏器功能不全综合征 (ＭＯＤＳ)患者救治中的作用。方法　 1 9例腹部外科疾病合并ＭＯＤＳ患者经中心静脉插管留置单针双导管 ,使用ＢａｘｔｅｒＢＭ2 5机器行连续性静脉 静脉血液滤过 (ＣＶＶＨ)方式治疗。于ＣＢＰ疗前、治疗后 2ｈ、4ｈ、6ｈ、8ｈ时分别抽取静脉血 ,采用ＥＬＩＳＡ法测定血浆肿瘤坏死因子αＴＮＦ α)、白细胞介素 1 (ＩＬ 1 )、白细胞介素 8(ＩＬ 8)的含量 ,并在每日早晨取静脉血检测ＵＮ、Ｓｃｒ、Ｋ+的浓度 ,同时取动脉血作血气分析。结果　 1 9例患者ＣＢＰ后血浆ＴＮＦ αＬ 1、ＩＬ 8水平均逐渐降低 (Ｐ < 0 0 5);血清ＢＵＮ、Ｓｃｒ、Ｋ+均逐渐明显下降 (Ｐ < 0 0 或< 0 0 1 ),动脉血气分析中ｐＨ、ＰａＯ2 、ＰａＣＯ2 、ＳａＯ2 指标均逐渐明显改善 ,差异有著意义 (Ｐ <0 0 5)。结论　ＣＢＰ能清除腹部外科疾病合并ＭＯＤＳ患者血浆中多种细胞因子 。Objective To explore the role of continuous blood purification(CBP) in treatment of abdominal surgical diseases associated with multiple organ dysfunction syndrome(MODS).Methods 19 patients met the criteria of abdominal surgical diseases associated with MODS.A double trunk catheter was put into the central vein and the continuous veno-venous hemofiltration(CVVH) was performed with the Baxter BM25 CBP.The plasma TNF-α,IL-1 and IL-8 were measured by ELISA at 0,2,4,6,8h following CBP,and the levels of Bun,Scr,serum K^+ and arterial blood gas were measured every morning.Results The plasma concentrations of TNF-α,IL-1 and IL-8 decreased gradually(P<0.05).The levels of Bun,Scr and serum K^+ decreased significantly following CBP(P<0.05 or <0.01).The results of pH,PaO_2,PaCO_2,SaO_2 in arterial blood gas were improved significantly following CBP(P<0.05).Conclusion CBP could remove many inflammatory cytokines in plasma,and improve the blood biochemical markers including Bun,Scr,serum K^+ and rterial blood gas in MODS patients.

关 键 词：治疗 患者 CBP 腹部外科疾病 多脏器功能不全综合征 MODS 连续性血液净化 

分 类 号：R459.5[医药卫生—治疗学]