血液灌流串联血液透析救治伴急性肾功能衰竭的多器官功能障碍综合征的临床研究  

Clinical Study of the Curative Effect of hemoperfusion with Hemodialysis on Patients of Multiple Organ Dysfunction Syndrome with Acute Renal Failure

作　　者：何承荣[1] 刘一李[1] 陈彦兴[1] 郭镇声[1] 

机构地区：[1]广东省东莞市虎门医院内科,广东东莞523911

出　　处：《赣南医学院学报》2007年第2期222-225,共4页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:研究血液灌流串联血液透析(HP+HD)救治伴急性肾功能衰竭(ARF)的多脏器功能障碍综合征(MODS)的疗效。方法:18例MODS在内科综合治疗的基础上,行HP+HD治疗,治疗前进行MODS评分,比较治疗前、后患者的血液生化指标、血气分析和C反应蛋白(CRP)、内皮素(ET)水平。结果:治疗后存活12例。与治疗前相比较,HP+HD治疗后氧合指数(PO2/FiO2)有明显改善,压力调整心率(PAHR)较治疗前降低(均P<0.05)。丙氨酸转氨酶(ALT)、总胆红素(TBIL)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB),纤维蛋白原(FIB)、CRP、ET明显下降(P<0.05),血尿素氮(BUN)、肌酐(Cr)、二氧化碳结合力(CO2-CP)显著改善(P<0.01)。结论:HP+HD治疗后心、肺功能的改善与脱水后组织器官间质水肿减轻有关,能有效清除炎症介质ET、CRP,改善肝、肾、心肌、凝血功能,改善患者预后。Objective：To evaluate the efficacy of hemoperfusion with hemodialysis （HP ＋ HD） on patients of multiple organ dysfunction syndrome（MODS） with acute renal failure （ARF）. Method：18 patients with MODS were treated HP ＋ HD with basic treatment of synthesize medicine. Blood biochemical, gas analysis, C -reactive protein （CRP） and endothelin （ET） were tested in pre - treatment, and post - treatment of HP ＋ HD. Meanwhile, MODS score were graded before the treatment. Results ： Compared with pre - treatment, Oxygenation index （FiO2/PO2 ） was improved obviously on post- treatment. Pressure -adjusted heart rate （PAHR） were decreased on post- treatment （P 〈 0.05）. Levels of alanime aminotransferase（ALT） and total bilirubin （TBIL） and creatine kinase （CK） and CPR and ET were decreased obviously （P 〈 0.05 ）. Blood urea nitrogen and creatinine and Carbon dioxide combining power （CO2 - CP） were decreased significantly （P 〈 0.01 ）. Conclusion The improvement of cardiac and pulmonary function was concerned with relieving interstitial edema of organization by HP ＋ HD, The treatment can promote the clearance of mediators ET and CRP and improve function of liver , renal , heart and blood coagulation. The prognosis of MODS with ARF is improved with HP ＋ HD. The treatment of HP ＋ HD appears to be a safe, effective, convenient and economic method for patients of MODS with ARF.

关 键 词：血液灌流 血液透析 急性肾功能衰竭 多脏器功能障碍综合征 

分 类 号：R692.5[医药卫生—泌尿科学]