高容量血液滤过对复苏后综合征的疗效观察  

Effects of high volume hemofiltration on outcome of post-res uscitation syndrome

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中心ICU,510150 [2]南方医科大学(第一军医大学)珠江医院神经外科,广州市510515

出　　处：《实用医学杂志》2004年第10期1093-1095,共3页The Journal of Practical Medicine

基　　金：广东省医学科研立项资助课题 (项目编号 :A2 0 0 2 589)

摘　　要：目的 :探讨高容量血液滤过 (HVHF)治疗心肺复苏后对低血压、低氧血症、脑水肿患者的治疗效果。方法 :心肺复苏后出现脑水肿合并低血压 ,低氧血症的患者 ( 2 9例 )分为两组 :治疗组 ( 14例 )行HVHF ,血流量为 2 5 0～ 3 0 0mL ,置换液为 3 0～ 4 0L/h ;对照组 ( 15例 )按常规治疗。观察生命体征、血液生化和GCS评分等变化。结果 :与对照组比较 ,治疗后 4～ 6h血压开始显著上升 ,多巴胺输注速度减少 ,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。结论 :高容量血液滤过 (HVHF)能清除体内细胞因子和乳酸等炎性介质 ,对提高血管活性物质的活性和氧交换、稳定内环境、减轻脑再灌注损伤 ,改善预后有重要的临床意义。Objective To assess the effect of high volume hemofiltration (HVHF ) on post-resuscitation syndrome, includes cerebral edema, allo-hemodynamics with hypoxemia following cardio-pulmonary resuscitation. Methods Twenty-nine inpatients with cerebral edema, hypotens ion and hypoxemia after cardio-pulmonary r e suscitation and were divided into two groups:(1)The treatment group (n=14 ), which underwent high volume hemofiltration(HVHF), the infusion rate of rep lace ment fluid was about 3.0～4.0 L/h and the blood flow was about 250～300 mL/h. (2)The control group (n=15) was deal with common method. During the trea tment, vital signs were continuing monitored, GCS, lactic acid, cytokine in plas ma were measured. Results None died during the course of the treatment group. C ompared with the control group, there was a significant increased in arterial pr essure and a drop in infusion rate of vasoactive drugs after 4～6 hour treatment ( P<0.05). It was a significant increased in PO 2/FiO 2 and a decreased in pl asma lactic acid, IL-1β, IL6, TNF-αwere found(P<0.05 or P<0.01). Conclusion High volume hemofiltration,with which enhance clearance of cytokines, improve homodynamic and ele vate the activity of dopamine, improve the oxygenation in lung. Ameliorate the d amage of reperfusion in brain. It is effective for conscious recovery and improv es the prognosis.

关 键 词：高容量血液滤过 对照组 复苏后综合征 心肺复苏 低血压 低氧血症 患者 分等 合并 下降 

分 类 号：R459.5[医药卫生—治疗学] R605[医药卫生—临床医学]