连续性血液净化在危重病中应用指征的临床研究  

Applied indication of continuous blood purification in critical illness

作　　者：王锦权[1] 刘宝[1] 陶晓根[1] 周彩平[1] 赵劲松[1] 承韶晖[1] 吴双正[1] 杜庆[1] 

机构地区：[1]安徽医科大学附属省立医院ICU,合肥230001

出　　处：《中国急救医学》2007年第10期881-884,共4页Chinese Journal of Critical Care Medicine

基　　金：安徽省卫生厅科学研究基金课题(No2002B007)

摘　　要：目的通过研究连续性血液净化(CBP)治疗对危重病患者预后的影响,探讨CBP在危重病领域使用的适应证。方法回顾性分析ICU收治并接受CBP治疗的危重病患者96例(CBP治疗279次)的临床资料,根据患者的预后分为存活组和死亡组,对其接受CBP治疗前的危重病评分、全身机能状况、原发疾病种类和使用CBP治疗的原因等进行相应比较。结果与存活组比较,死亡组患者的危重病评分较高(P<0.01),压力调整心率、血清碱性磷酸酶、γ-谷氨酰基转移酶、总胆红素均较高(均P<0.01),血糖也较高(P<0.05),而血清胆固醇和白蛋白较低(P<0.01),血小板计数也较低(P<0.05);患者出现多器官功能障碍时有急性肾功能衰竭者死亡率较高(P<0.05),脑出血和多发伤患者需要接受CBP治疗时预后也较差。结论CBP治疗可以短期减轻患者的病情,为进一步治疗争取时间;但患者的预后取决于疾病的严重程度、原发病能否得到有效控制和出现肝功能不全等;并据此提出使用CBP治疗的适应证。Objective To observe the effect of continuous blood purification （CBP） on the prognosis and discuss the indications of CBP in critical illness. Methods To analyze retrospectively the data of 96 critically ill patients （ 279 times ） with CBP therapy in ICU. According to the prognosis, the patients were divided into the survival group and the death group. The critical illness scores, the function of main organs before CBP treatment, the sorts of primary diseases and the reasons of using CBP in two groups were compared. Results Compared with survival group, the scores of APACHE Ⅱ , SAPS Ⅱ , MODS, TISS, the pressure - adjusted heart rate, ALP, GGT and TB were higher （ P 〈0.01 ） , and the concentration of serum Glu was also higher in the death group （ P 〈 0.05 ） , but serum cholesterol and albumin were lower （ P 〈 0.01 ） and blood platelet count was lower in the death group （ P 〈 0.05 ）. The mortality of the patients with multiple organ damage and acute renal failure was higher than that with multiple organ damage alone （P 〈0.05）. Those patients with cerebral hemorrhage and multiple injury undergoing CBP therapy had poor prognosis. Conclusions CBP therapy could relieve the discomfort temporarily, and be helpful to further treatment. The prognosis depends on the severity of disease and the primary affection and liver function and so on. According to those, the indications of CBP therapy were put forward.

关 键 词：连续性血液净化 适应证 危重病 预后 

分 类 号：R459.5[医药卫生—治疗学]