高容量连续性静脉-静脉血液滤过治疗多脏器功能障碍综合征(13例临床分析)  

HIGH VOLUME CONTINUOUS VENO VENOUS HEMOFILTRATION IN MULTIPLE ORGAN DYSFUNCTION SYNDROME-AN ANALYSIS OF 13 CASES

作　　者：丁峰[1] 顾勇[1] 陆福明[1] 樊淑玲[1] 薛俊 李铭新[1] 杨海春[1] 徐雅萍 林善锬[1] 

机构地区：[1]上海医科大学华山医院肾脏病科

出　　处：《肾脏病与透析肾移植杂志》1998年第6期529-533,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的：探讨高容量连续性静脉－静脉血液滤过治疗多脏器功能障碍综合征的效果。方法：１３例多脏器功能障碍综合征患者接受３．０～４．０Ｌ／ｈ置换液输入速度的连续性静脉－静脉血液滤过技术，平均治疗时间为６２．３ｈ。结果：１３例患者死亡６例，存活７例；９例治疗前需用升压药维持血压的患者治疗后３０ｍｉｎ平均动脉压有显著上升，心率则有显著下降；治疗后１２ｈ血清Ｎａ＋、Ｃｌ－、Ｃａ２＋和动脉血气中的ｐＨ、ＨＣＯ－３、ＰＯ２、ＰＣＯ２均无显著变化，而血清ＢＵＮ、Ｃｒ、Ｋ＋则有显著下降；血浆ＩＬ－１β、ＴＮＦ－α水平在治疗后１２ｈ也有显著下降；治疗后３０ｍｉｎＩＬ－１β、ＴＮＦ－α的筛系数显著低于治疗后１２ｈ的筛系数。结论：高容量连续性静脉－静脉血液滤过能清除大量的细胞因子，改善血流动力学。OBJECTIVE To study the effect of high volume continuous veno venous hemofiltration in multiple organ dysfunction syndrome. METHODOLOGY 13 patients with multiple organ dysfunction syndrome underwent high volume continuous veno venous hemofiltration of a mean duration of 62 3 hours.The infusion rate of replacement fluid was about 3 0～4 0 L/hr. RESULTS 6 patients died during the course of treatment.There was a significant increase in mean arterial pressure and a drop in heart rate after 1/2 hour treatment in 9 cases who required vasoactive drugs to maintain blood pressure.No change was found in serum Na +,Cl -,Ca 2+ and in blood pH,HCO 3- ,PO 2,Pco 2 after 12 hours therapy,while a significant decrease in serum BUN,Cr,K + and plasma IL 1β,TNF α was found.The sieve coefficients of IL 1β,TNF α after 1/2 hour treatment were greater than those after 12 hours treatment. CONCLUSION High volume continuous veno venous hemofiltration,with which enhanced clearance of cytokines and improved hemodynamics can be achieved,is an effective treatment for multiple organ dysfunction syndrome.

关 键 词：血液滤过 细胞因子 多器官障碍 

分 类 号：R590.5[医药卫生—内科学] R459.5[医药卫生—临床医学]