连续性血液净化在危重症并低血压时的应用及临床干预  

Application of continuous blood purification therapy and clinical intervention for severe case complicating hypotension

作　　者：邹延红[1] 周秀华[1] 

机构地区：[1]中国医科大学附属第四医院危重症治疗科,辽宁沈阳110032

出　　处：《新乡医学院学报》2010年第5期486-488,共3页Journal of Xinxiang Medical University

摘　　要：目的探讨应用连续血液净化(CBP)治疗危重症并低血压的疗效及临床干预措施。方法 36例危重症并低血压患者均行血液净化治疗,在血液净化治疗的同时给予一定的临床干预,并动态监测患者治疗后血气分析、肝肾功能、电解质、动脉血乳酸、血管活性药物使用剂量及血清肿瘤坏死因子(TNF-α)水平等,以急性生理学与慢性健康状况评分Ⅱ(APACHE-Ⅱ)来判断整体病情的变化。结果 36例中30例救治成功,总体存活率83.33%,其中血管活性药物依赖时间12～84h,平均(22.5±17.5)h;30例救治成功患者经连续性静脉-静脉血液滤过(CVVH)24h后血压基本稳定(P>0.05);与CBP前比较,CBP后血管活性药物剂量明显降低(P<0.05),血气指标及生化指标好转(P<0.05)。治疗前和治疗结束后比较APACHE-Ⅱ评分及TNF-α差别均有统计学意义(P<0.05)。结论危重症并低血压患者在血液净化治疗开始阶段给予一定的干预措施,能使患者血流动力学状态快速稳定,及时进行血液净化可以避免发生不可逆转性器官功能损害。Objective To study the therapeutic effect of continuous blood purification （ CBP） and clinical intervention for severe case complicating hypotension. Methods Thirty-six patients with severe disease complicating hypotension were treated with CBP and clinical intervention at the same time. The patient＇s blood gas analysis,hepatic function,renal function,electrolyte, lactic acid in arterial blood,vasoactive agent dose and serum tumor necrosis factor（ TNF-α） level were monitored. The patients＇ condition were evaluated by acute physiology and chronic health evaluation Ⅱ（ APACHE-Ⅱ） . Results Among thirty-six cases, thirty patients were recovery,and the survival rate was 83. 33% . The time of depending on vasoactive agent was 12 - 84 hours and the average time was （ 22. 5 ± 17. 5） hours. The blood pressure of the cases who treated with continuous veno-venous hemofil- tration （ CVVH） for 24 hours were stable. Compared with pretherapy of CBP,vasoactive agent dose decrease and biochemical indicators improved（ P〈 0. 05） . There were significant difference in APACHE-Ⅱscores and TNF-α levels between preand posttreatment（ P 〈0. 05） . Conclusion It can make hemodynamic stabilization fastly to give clinical intervention at the beginning of CBP. The CBP therapy can avoided the occurrence of irreversible organ function danmage.

关 键 词：连续血液净化 危重症并低血压 临床干预 

分 类 号：R459.5[医药卫生—治疗学]