不同剂量连续性静脉静脉血液滤过对多器官功能障碍综合征疗效的影响  

Effectiveness of different doses in continuous veno-venous hemofiltration for the patients with multiple organ dysfunction syndrome

作　　者：张近宝[1] 张渝华[2] 欧阳辉[1] 丁盛[1] 高峰[1] 邬晓臣[1] 梁瑜[1] 

机构地区：[1]成都军区总医院心血管外科,四川610083 [2]成都军区总医院重症医学科,四川610083

出　　处：《中国急救医学》2011年第5期405-408,共4页Chinese Journal of Critical Care Medicine

基　　金：四川省卫生厅计划项目（No.100189）,四川省卫生厅资助项目（No.100095,100190）

摘　　要：目的 探讨以不同置换液剂量行连续性静脉静脉血液滤过（CVVH）对多器官功能障碍综合征（MODS）疗效的影响.方法 回顾性分析成都军区总医院自2004-01～2010-10期间行CVVH治疗的68例MODS患者,采用单盲法随机分组,按置换液剂量分低剂量组[20～35 mL/（kg·h）]、中等剂量组[35～45 mL/（kg·h）]和高剂量组[50～70 mL/（kg·h）];对比分析各组的年龄、少尿期持续时间、平均CVVH治疗时间和平均机械通气时间,并将CVVH治疗前和治疗24 h后的APACHEⅡ评分、SOFA评分、氧合指数、血尿素氮（BUN）、血浆肌酐（Cr）及平均动脉压（MAP）等结果进行比较.结果 ①三组患者年龄、CVVH治疗前APACHEⅡ评分、SOFA评分、氧合指数、BUN、Cr和MAP差异无统计学意义（P＞0.05）.②低剂量组患者少尿期持续时间、平均CVVH治疗时间、平均机械通气时间明显长于中等剂量和高剂量组（P＜0.05）;中等剂量组患者少尿期持续时间、平均CVVH治疗时间、平均机械通气时间明显长于高剂量（P＜0.05）.③经CVVH治疗24 h,全部患者氧合指数、BUN、Cr和MAP均明显改善（P＜0.05）;中等剂量和高剂量两组行CVVH治疗24 h后的APACHEⅡ评分、SOFA评分明显降低（P＜0.05）,低剂量组无明显变化（P＞0.05）.结论 以较高置换液剂量行CVVH有助于缓解MODS的病情.Objective To investigate the therapeutic effect of different doses in continuous venovenous hemofihration （CVVH） for the patients with multiple organ dysfunction syndrome （MODS）. Methods We retrospectively studied 68 patients with MODS from the General Hospital of Chengdu Military Command, these patients were treated with CVVH from Jan. 2004 to Oct. 2010. According to the volume of substitute fluid in CVVH, all of them were divided into 3 groups by the singleblind way： small dosage group [ 20 -35 mL/（ kg·h）], middle dosage group [ 35 -45 mL/ （kg· h） ] , larger dosage group [ 50 - 70 mL/（ kg · h ） ]. Their age, oliguria duration, length of total hemofihration and duration of total mechanical ventilation were compared among 3 groups. Their APACHE Ⅱ score, sequential organ failure assessment（SOFA） score, oxygenation index, blood urea nitrogen（BUN） ,serum creatinine, mean arterial pressure（MAP） were also compared before CVVH and after 24- hour CVVH. Results ①There were no significances in APACHE Ⅱ score, SOFA score, oxygenation index, BUN, serum creatinine, MAP before CVVH and age among 3 groups （P 〉 O. 05）. ②Oliguria duration, length of total hemofiltration and duration of total mechanical ventilation in small dosage group were longer than those in middle and larger dosage groups （ P 〈 0.05 ）. The above -mentioned indexes were longer in middle dosage group than in larger dosage group （ P 〈 0.05 ）. ③Mter 24 -hour CVVH, oxygenation index, BUN, serum creatinine and MAP improved significantly in all the patients, APACHE Ⅱ score and SOFA score decreased significantly in middle and larger dosage groups （ P 〈 0.05 ）, but there was no obvious changes in small dosage group （ P 〉 0.05 ）. Conclusion Larger dosage of substitute fluid in CVVH can improve MODS.

关 键 词：连续性静脉静脉血液滤过(CVVH) 多器官功能障碍综合征(MODS) 剂量 急性肾损伤(AKI) 置换液 

分 类 号：R473.5[医药卫生—护理学]