连续性血液净化对多脏器功能障碍综合征患者血管内皮功能的影响  

Effect of Continuous Blood Purification on Vascular Endothelial Function in Patients with Multiple Organ Dysfunction Syndrome

作　　者：林勇军[1] 熊滨[1] 

机构地区：[1]广西壮族自治区人民医院内科ICU,广西南宁530021

出　　处：《医学临床研究》2011年第3期416-419,共4页Journal of Clinical Research

摘　　要：[目的]探讨连续性血液净化（CBP）在多器官功能障碍综合征（MODS）患者应用中对血管内皮细胞（VEC）功能的影响.[方法]MODS患者39例入治疗组,于CBP前、CBP开始后4 h、12 h、24 h、48 h、72 h测定心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、心排血量指数（CI）,于CBP前、CBP开始后4 h、12 h、24 h、48 h、72 h及CBP治疗结束后6 h、24 h留取血标本,测定同型半胱氨酸（Hcy）,内皮素-1（ET-1）,一氧化氮（NO）;治疗前,治疗后24 h、48 h、72 h行急性生理功能和慢性健康状况（APACHEⅡ）评分.同时以未行CBP治疗的MODS患者25例作为对照,在诊断后0 h、4 h、12 h、24 h、48 h、72 h留取血标本.比较两组上述指标水平及28 d病死率差异.[结果]治疗后两组血流动力学指标及APACHE Ⅱ评分均有改善（P〈0.05）,与对照组相比,治疗组改善更为明显（P〈0.05）;治疗组Hcy ,NO,ET-1随着治疗时间延长逐渐得到改善（P〈0.05）;而对照组上述指标改变不明显（P＞0.05）.两组患者28 d病死率无统计学差异（P〉0.05）.[结论]CBP能通过改善MODS患者的VEC功能,改善血流动力学,改善氧合功能,从而起到对MODS的治疗作用.[Objective] To investigate the effect of continuous blood purification（CBP） on vascular endothelial cell（VEC） in patients with multiple organ disorder syndrome（MODS）. [Methods] Thirty-nine patients with MODS in treatment group received CBP. Heart rate（HR）, mean arterial pressure（MAP）, central vein pressure（CVP） and cardiac index（CI） were measured at 4h, 12h, 24h, 48h and 72h after CBP. Homocysteinemia（Hcy）, endothelin-1 （ET-1） and nitric oxide（NO） were measured before and at 4h, 12h, 24h, 48h and 72h after CBP and 6h, lgh after CBP was stopped. APACHEII score was recorded before and at 24h, 48h and 72h after CBP. Twenty-two patients in the control group did not receive CBP. Above indexes and the 28 day mortality were compared between two groups. [Results]The hemodynamic indexes and APACHEII score were improved in two groups after treatment（ P 〈0.05）. Compared with the control group, the treatment group was improved more better（ P〈0.05）. Hcy, NO and ET-1 in treatment group were improved gradually with the time（ P 〈0.05）, while there was no significant change in the plasma levels of control group（ P 〈 0. 05）. There was no significant difference in 28-day mortality between two groups（ P 〉0.05）. [Conclusion]CBP can treat MODS through improving the function of VEC, hemodynamics and oxygenation of MODS patients.

关 键 词：多器官功能衰竭 血液过滤 内皮 血管 

分 类 号：R365[医药卫生—病理学]