连续性静脉-静脉血液滤过对多脏器功能障碍综合征APACHEⅡ积分及C反应蛋白的影响  

Effects of continuous veno-venous hemofiltration on serum C-reactive protein level and APACHEⅡ score in patients with multiple organ dysfunction syndrome

作　　者：苏伟[1] 黄昭[1] 王思荣[1] 陈裕胜[1] 许东琳[1] 吴晓琴[1] 刘宗师[1] 林明[1] 杨智[1] 程园园[1] 于晓春[1] 林材元[1] 

机构地区：[1]广东省广州市第一人民医院危重病监护中心,广州510180

出　　处：《临床医学》2009年第3期1-5,共5页Clinical Medicine

摘　　要：目的观察连续性静脉-静脉血液滤过(CVVH)治疗多器官功能衰竭(MODS)患者中APACHEⅡ积分、C反应蛋白水平、临床疗效及治疗中并发症的情况。方法选择2003年1月至2007年12月在本中心接受CVVH治疗的34例MODS患者,年龄19～91岁,平均(64±19)岁,APACHEⅡ积分为24.6±3.4,观察CVVH疗效及治疗过程中患者血压、心率、体温、呼吸等生命体征变化,监测其肝、肾功能,同时观察CVVH治疗中并发症情况。结果34例患者中存活时间超过14 d的有25例(73.6%),最终存活10例(29.4%),全部患者均存在肾功能衰竭,经CVVH治疗后明显好转。存活组年龄[(61±20)岁]明显低于死亡组[(72±16)岁],P<0.05,同时呼吸衰竭、凝血功能紊乱及心功能衰竭的发生率均明显低于死亡组。所有患者对CVVH治疗均耐受良好,治疗过程中血压、心率平稳,血流动力学稳定,存活组患者APACHEⅡ积分在治疗过程中明显下降,8例并发出血患者均因自身凝血功能紊乱所致出血。结论CVVH治疗用于MODS患者的救治安全可靠,并发症少,可有效缓解患者病情,保护脏器功能,是MODS患者救治中重要的治疗手段之一。治疗过程中患者耐受良好,血流动力学稳定,APACHEⅡ积分及C反应蛋白水平下降,两者的动态变化趋势有助于判断MODS患者的预后。Objective To evaluate the effects of continuous veno - venous hemofihration （CVVH） on serum C - reactive protein and APACHE Ⅱ score in patients with muhiple organ dysfunction syndrome （MODS）. Their clinical characteristics and the complications during CVVH were also observed. Methods Thirty - four patients with MODS, aged 19 - 91 years old, average age was （64± 19） years, APACHE Ⅱ score was 24. 6 ± 3.4, were involved this study. The clinical conditions including blood pressures, heart rate, temperature, and respiratory condition were monitored every hour, also the liver function and renal function were monitor after the initiation of CVVH. The complications were investigated. Results Of 34 patients, 25 patients survived through 14 days after CVVH （ 14 - days survival rate 73.6% ）. Renal failure was presented in all patients before CVVH, and renal function all recovered after CVVH. Averaged age of survival patients was significantly lower than non - survival patients, and respiratory failure, coagulation disorder and heart failure in survival patients were also lower than in non - survival patients. CVVH was well tolerated in all of patients, who were maintained in a steady state of blood pressure and heart rate during CVVH. The APACH Ⅱ score was decreased during CVVH in survival patients. The complications were bleeding in 8 cases all because of primary coagulation disorder. Conclusion CVVH therapy can get a survive rate of 29.4% and 14 - days survive rate of 73.6% in patients with MODS, which was well tolerated because of low complication rate. The APACHE Ⅱ score and CRP level declined after CVVH, which may help to predict the outcome of patients with MODS.

关 键 词：血液净化 多器官功能衰竭综合征 临床疗效 APACHEⅡ积分 C反应蛋白 

分 类 号：R459.7[医药卫生—急诊医学]