配对血浆滤过吸附治疗重症感染并多器官功能障碍综合征  

Effects of coupled plasma filtration Absorption on MODS patients

作　　者：毛慧娟[1] 余姝[1] 张波[1] 俞香宝[1] 张莉[1] 许贤荣[1] 沈霞[1] 王笑云[1] 邢昌赢[1] 

机构地区：[1]南京医科大学第一附属医院肾脏病科,210029

出　　处：《江苏医药》2008年第10期973-976,共4页Jiangsu Medical Journal

基　　金：江苏省人民医院新技术引进项目(200506)

摘　　要：目的探讨配对血浆滤过吸附(CPFA)治疗重症感染并多器官功能障碍综合征(MODS)的临床疗效。方法MODS患者7例,均在常规药物治疗基础上加用CPFA和高容量血滤(HVHF)治疗各10 h,治疗顺序随机,间隔一夜洗脱期(12 h),比较两种血液净化方式的临床效果及对C反应蛋白(CRP)的影响。结果(1)两种治疗平均动脉压(MAP)均明显升高,且升压药应用量减少。APACHEⅡ评分:CPFA治疗前25.25±7.18,治疗后降至19.00±6.83(P<0.05)。(2)与HVHF相比,CPFA同样能很好地维持机体电解质、酸碱的平衡状态,明显降低血尿素氮、肌酐水平,改善血氧分压和氧合指数。(3)CPFA治疗后CRP由(124.92±43.88)mg/L降至(94.66±35.43)mg/L(P<0.05),降势明显大于HVHF后(P<0.05)。(4)CPFA治疗过程中无一例发生凝血、出血、过敏、栓塞等不良反应。(5)患者的平均预期病死率是54%,实际5例存活,1例死亡,1例自动出院。结论CPFA治疗MODS有效、安全,在降低CRP方面优于HVHF。Objective To investigate the effects of a novel extracorporeal blood purification therapy with coupled plasma filtration absorption （CPFA） on the multiple organ dysfunction syndromes（MODS） in patients with severe infection. Methods Seven patients diagnosed MODS with severe infection randomly received twice treatments of CPFA and high volume hemofiltration （HVHF） for 10 hours each in a random order with 12 hours interval. The clinical outcome and serum C reactive protein（CRP） level were compared after two therapies. Results （1）Mean arterial pressure （MAP） increased and dopamine requirements decreased after 10 hours treatment with CPFA or HVHF. APACHEⅡ score decreased from 25.25 ± 7.18 before to 19.00 ± 6.83 after treatment of CPFA （P〈0.05）. （2）Kidney function and oxygenation index were improved, and electrolytes balance and acid-base balance were well maintained after CPFA therapy. （3）CRP decreased from（ 124.92 ± 43.88） mg/L to （94. 66±35.43） mg/L with treatment of CPFA （P〈0.05） and the decrease was greater than that with treatment of HVHF （P〈0.05）. （4）No therapy-related adverse reactions, including severe haemorrhage, shock, hypersensitivity, were noted. （5）The total survival rate of patients was 71.4% （5/7 cases） with an average estimated mortality of 54% by the end of the treatments. Conclusion CPEA was the same effective and safe as HVHF in treating MODS patients. CPFA was superior to HVHF in decreasing CRP.

关 键 词：配对血浆滤过吸附 高容量血液滤过 多器官功能障碍综合征 

分 类 号：R692.5[医药卫生—泌尿科学]