高容量血液滤过对急重型弥散性脑肿胀治疗的临床研究  

The effects of high volume hemofiltration in the treatment of acute severe diffuse brain swelling

作　　者：赵灵[1] 林小华[2] 沈东波[3] 李永波[1] 楚磊[1] 侯玉宇[1] 

机构地区：[1]暨南大学医学院第三附属医院外科ICU,广东省519000 [2]中山市人民医院神经外科 [3]暨南大学医学院第三附属医院血透室

出　　处：《临床医学》2005年第12期4-7,共4页Clinical Medicine

摘　　要：目的观察使用高容量血液滤过(血滤)对急重型弥散性脑肿胀治疗效果的临床研究.方法34例诊断为急重型弥散性脑肿胀、GCS评分为3～6分的病人被随机分成两组:治疗组(n=17)和对照组(n=17).治疗组的病人入院后即给予高容量血液滤过治疗,置换液为3.0～4.0L/h,血流量为200～300ml/min,时间为3～5d;对照组按普通常规治疗.两组病人均用血清神经元特异性烯醇酶连续监测1周,GCS在治疗后1、10、20d和GOS于3个月后进行检验、评估及统计.结果治疗组和对照组的血清NSE和GCS分别为(12.4±2.2)μg/L、(9.6±2.6)μg/L和(26.3±2.8)μg/L、(6.3±2.3)μg/L,两组有明显差异(P＜0.01).3个月后GOS评估,治疗组优于对照组,GOS 4～5级:治疗组7例(41.1%),对照组3例(17.7%);死亡:治疗组6例(35.3%),对照组9例(52.9%).结论早期使用高容量血液滤过对急重型弥散性脑肿胀的治疗有明显疗效.Objective To observe the clinical effects of high volume hemofihration（HVHF） in the treatment of acute severe diffuse brain swelling （ASI）BS）. Methods There were 34 patients suffered from ASI）BS and had Glasgow coma scale（GCS） scores of 3-6 were divided randomly into two groups：HVHF treatment group （n=17） and control group （n=17）, HVHF treatment group：which underwent high volume hemofiltration , the infusion rate of replacement fluid was about 3.0-4.0L/h and the blood flow was about 200-300mL/min, for 3-5d; The control group was dealt with common method. Serum neuron specific enolase （NSE） was measured everyday for 7d; GCS score was recorded on thel st, 10th and 20th day; Outcome was determined by Glasgow outcome scale （GOS） score after 3 months respectively and the data were analyzed statistically. Results The serum NSE, GCS in the HVHF group were （12.4±2.2）μg/L, （9.6±2.6）μg/L, while the serum NSE, GCS in control group were （26.3±2.8）μg/L, （6.3±2.3）μg/L, respectively. Between the two groups serum NSE, GCS were different significantly（P〈0.01）. After 3 months, according to GOS, outcome of the study group was improved, with GOS 4-5（41.1% vs 17.7%）; and mortality rate 35.3% vs 52.9%. Conclusion Early using of high volume hemofiltration in the treatment of posttraumatic acute severe diffuse brain swelling is effective.

关 键 词：血液滤过 弥散性脑肿胀 神经元特异性烯醇酶 

分 类 号：R651[医药卫生—外科学]