连续性血液净化在热射病并发高热及多脏器功能障碍综合征中的应用  

The application of continuous blood purification for high fever and multiple organ dysfunction syndrome after heat stroke

作　　者：赵寒辉[1] 孟建中[1] 张洪彬[1] 葛彦明[1] 吕苏一[1] 王素霞[1] 景颖[1] 高利群[1] 刘文渊[1] 

机构地区：[1]济南军区总医院血液净化科,250031

出　　处：《国际移植与血液净化杂志》2012年第2期20-22,共3页International Journal of Transplantation and Hemopurification

摘　　要：目的探讨连续性血液净化救治热射病并发高热及多脏器功能障碍综合征的临床效果。方法应用AsahiKSEIACH-10CRRT机持续静脉-静脉血液滤过模式辅助治疗热射病高热并多器官功能障碍。10例患者均为物理降温及药物治疗效果差，在多器官功能障碍状态下接受连续性血液净化治疗共计727h。结果（1）连续性血液净化治疗中患者平均动脉压、中心静脉压、急性生理学及慢性健康状况评分指标与治疗前比较差异有统计学意义（P〈0．05）；血肌酐、肌酸激酶水平与治疗前比较差异也有统计学意义（P〈0．05）；（2）全部患者均治愈出院，无后遗症，平均连续性血液净化治疗时间为（56±29）h；（3）对5例严重昏迷、并发急性呼吸窘迫综合征、弥散性血管内凝血患者连续实施连续性血液净化治疗平均69h，当其意识恢复、气管插管拔除后停止连续性血液净化治疗。结论采用连续性血液净化技术辅助治疗热射病高热及多器官功能障碍可有效缓解症状，为进一步使用药物及其他治疗争取时间，是一种有效地辅助治疗手段。Objective To evaluate the outcome of continuous blood purification （CBP） on treatment for high fever and multiple organ dysfunction syndrome （MODS）. Occured to patients after heat stroke（HS）. Methods Ten heat stroke patients who suffered from high fever and multiple organ dysfunction was treated with physical cooling and drug treatment without obvious effect received CBP therapy for 927 hours with Asahi Kasei AsahiKSEI ACH-10CRRT machine. Results （1）Index of mean arterial pressure, central venous pressure, acute physiology and chronic health evaluation were improved significandy （ P 〈 0.05） ; Meanwhile, the level of serum ereatinine and ereatine kinase were significant deseented during CBP （ P 〈 0.05）. （2）All of patients were cured without sequela and were discharged from hospital, the average time of CBP therapy is （56 ± 29）h. （3）69 h sequential CBP to 5 patient who suffered with cataphora, acute respiratory distress syndrome（ARDS） and disseminated intravascular coagulation（DIC）. CBP was stopped after his consciousness recoverd and the tracheal cannula exelcymosised. Conclusion CBP is an effective adjuvant treatment method for malignant hyperthermia and multiple organ dysfimction after heat stroke. It can control high fever, the patients can obtain an opportunity to receive effective drug and other treatment.

关 键 词：热射病 连续性血液净化 高热 多脏器功能障碍综合征 

分 类 号：R459.7[医药卫生—急诊医学]