连续性肾脏替代疗法在多器官功能障碍综合征中的应用  

Continuous renal replacement therapy in multiple organ dysfunction syndrome

作　　者：王峥嵘[1] 

机构地区：[1]河南省商丘市第一人民医院血液净化中心,476100

出　　处：《中国医师进修杂志》2010年第10期12-14,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的观察连续性肾脏替代疗法（cRRT）治疗多器官功能障碍综合征（MODS）的疗效，探讨其应用价值。方法用CRRT方法治疗MODS患者46例，观察CRRT治疗前后患者血气分析、毒素清除、电解质的波动及急性生理和慢性健康状况Ⅱ评分（APACHEⅡ评分）的变化情况。结果治疗开始时APACHEⅡ评分为（20．8±4．4）分，临床治愈31例，APACHEⅡ评分（13．6±4．9）分，死亡15例。存活的患者，治疗过程中血压、血气分析、电解质、毒素清除等指标逐渐好转，治疗前后比较差异有统计学意义（P〈O．05）。8例治疗前休克需要升压药物维持血压者，治疗后6例逐渐减量停药，合并心力衰竭者治疗过程中心功能稳定，4例肺部感染诱发MODS，治疗过程中内环境稳定，治疗后尿量均有不同程度的好转，最终因病原菌耐药2例死亡。结论CRRT是MODS患者的有效治疗方法，能有效清除体内代谢产物和炎性介质，重建机体免疫内稳态。Objective To observe the efficacy of continuous renal replacement therapy （CRRT） treatment in multiple organ dysfunction syndrome （MODS）,and explore its application value. Methods Forty-six eases of MODS were treated with CRRT. Blood gas analysis, toxin removal, electrolyte and APACHE Ⅱ score was observed before and after treatment. Results The APACHE Ⅱ score in the beginning of treatment was （20.8 ± 4.4） scores, 31 cases had clinical cure, and APACHE Ⅱ score was （13.6 ± 4.9） scores, 15 eases died. In patients of survival, blood pressure,blood gas analysis,electrolytes,toxin removal improved gradually,and the difference had statistical significance before and after treatment. In 8 eases with shock before treatment who need drugs to maintain blood pressure, after treatment 6 cases withdrew drugs gradually. In the coupe of treatment, heart function was stable in patients who had heart failure. Four cases had pulmonary infection-induced MODS. In the process of the treatment internal environment was stable, and urine after treatment improved in different degrees. Two cases died of drug-resistant pathogens ultimately. Conclusions CRRT is an effective method in the treatment of MODS patients. CRRT can effectively clear the metabolites and inflammatory mediators, and rebuild the immune homeostasis of the body.

关 键 词：肾替代疗法 多器官功能衰竭 细胞毒素类 治疗应用 

分 类 号：R459.7[医药卫生—急诊医学]