连续静脉-静脉血液滤过救治多脏器功能失常综合征  

Treatment of multiple organ dysfunction syndrome by continuous venous-venous hemofiltration

作　　者：王允野[1] 梁文胜[2] 刘伟恒[2] 牛涧峰[2] 张志博[2] 

机构地区：[1]吉林医药学院附属四六五医院润消化科,132000 [2]吉林市中心医院ICU

出　　处：《中国急救复苏与灾害医学杂志》2009年第12期965-968,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的总结持续静脉-静脉血液滤过（CVVH）在多脏器功能失常综合征（MODS）中的治疗作用。方法CVVH治疗组为ICU中MODS患者31例，男19例，女12例，18-78岁，除给予常规治疗外，应用德国贝朗Diapact持续肾替代治疗机连续治疗48～72h，以后行每天8h的日间血滤，治疗时间共64～102h；同时35例MODS患者，男22例，女13例，年龄21～81岁，仅给予常规治疗。治疗期间监测生命体征，血常规，电解质，氧合指数（PO2/FIO2）。血糖，凝血功能，白蛋白（ALB），肌酐（CRE），尿素氮（BUN），C-反应蛋白（CRP），格拉斯哥评分（GSC），MODS评分，急性生理学和慢性健康评分Ⅱ（APACHEⅡ）。结果CVVH治疗组ICU7d转出率为100％，明显高于对照组（25．7％。P〈0．01），治疗组7d病死率为0，显著低于对照组（37．1％，P〈0．01），并且治疗组总的住院病死率为12．9％，明显低于对照组（48．6％，P〈0．01）。CVVH治疗后血清白蛋白、Na^＋、氧分压（PO2）及GSC均显著高于治疗前（P〈0．01）。血清K^＋、Ca^＋、pH值、HCO^3-及PO2／FIO2滤过后均高于治疗前（均P〈0．05）。体温、呼吸频率、二氧化碳分压（PCO2）、BUN、CRE、CRP、APACHEⅡ／、MODS评分均显著低于治疗前（均P〈0．01）。治疗组心率、中心静脉压低于治疗前（均P〈0．05）。结论CVVH具有多器官功能支持治疗的功能，CVVH是治疗多脏器功能失常综合征的有效方法。Objective To investigate the effects of continuous venous-venous hemofiltration （CVVH） in treatment of multiple organ dysfunction syndrome（MODS）. Methods 31 patients with MODS, 19 males and 12 females, aged 18-78, underwent, in addition to routine treatment, CVVH with Braun Diapact continuous renal replacement therapy machine in ICU for 48-72 hours and then 8 h a day during daytime, with a total CVVH time of 64-102h; and 35 MODS patients, 22 males and 13 females, aged 21-81, underwent routine treatment only. During the treatment, the life signs, blood routine, electrolytes, hematopneic index （PO2/FIO2） , blood sugar, coagulation function, serum albumin （ALB）, creatinine （CRE）, blood urea nitrogen （BUN）, C-reactive protein （CRP）, Glasgow score （GSC）, multiple organ dysfunction（MODS） score, and acute physiology and chronic health evaluation U （APACHE Ⅱ ） were monitored. Results The 7d ICU transfer rate of the CVVH group was 100%, significantly higher than that of the control group （25.7%, P〈0.01）, the 7d ICU mortality of the CVVH group was 0, significantly lower than that of the control group （37.1%, P〈0.01）, and the general in-hospital mortality of the CVVH group was 12.9%, significantly lower than that of the control group （48.6%, P〈0.01）. The levels of serum ALB , Na^＋, partial pressure of oxygen （PO2） and GSC after CVVH were all significantly higher than those before CVVH （all P〈0.01）. The levels of serum K^＋, Ca^2＋, pH, HCO^3- and PO2/FIO2after CVVH were all higher than those before CVVH （all P〈0.05）. The levels of body temperature, respiratory rate, PCO2 , BUN, CRE, CRP, APACHE Ⅱ , and MODS score after CVVH were all significantly lower than those before CVVH （all P〈0.01）. The heart rate and CVP after CVVH was both lower than that before CVVH （both P〈0.05）. Conclusion Effective in treatment of MODS, CVVH has the function of multiple organ support therapy.

关 键 词：连续静脉—静脉血液滤过 多脏器功能失常综合征 

分 类 号：R459.7[医药卫生—急诊医学]