PE联合CVVH治疗挤压综合征患者临床疗效研究  

The effect of CVVH combined with PE in the treatment of patients with crush syndrome

作　　者：刘涵[1] 苟亚军[1] 彭东[1] 徐世伟[1] 刘明华[1] 

机构地区：[1]第三军医大学西南医院急救部,重庆400038

出　　处：《临床急诊杂志》2015年第8期585-587,共3页Journal of Clinical Emergency

摘　　要：目的:探讨血浆置换(PE)联合连续静脉-静脉血液滤过(CVVH)治疗挤压综合征(CS)患者的有效性。方法:将2013-01-2014-12在我院明确诊断为CS的60例患者随机分为CVVH组(n=30例)和CVVH+PE组(n=30例),CVVH组患者予以CVVH等常规治疗,CVVH+PE组在CVVH治疗方案的基础上,加用PE治疗。监测和记录2组患者治疗前和治疗24、48、72h的血清肌红蛋白(MB)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、血清肌酐(CREA)、血清尿素氮(BUN)以及APACHEⅡ评分指标的变化,并进行统计学分析。结果:2组患者治疗24、48、72h的MB、CK、CK-MB、LDH、CREA、BUN及APACHEⅡ评分指标均较治疗前显著降低(P<0.05)。其中,CVVH+PE组患者治疗24、48、72h的MB、CK、CK-MB、LDH和APACHEⅡ评分均明显低于CVVH组(均P<0.05)。结论:与单纯行CVVH治疗相比,PE联合CVVH早期治疗CS更有效,值得在临床中推广应用。Objective：To investigate the effect of continuous veno-venous hemofihration（CVVH）combined with plasma exchange（PE）in the treatment of patients with crush syndrome（CS）.Method：Sixty patients diagnosed with CS in our department from Jan 2013 to Dec 2014 were selected and randomly divided into CVVH group（n=30cases）and CVVH＋PE group（n=30cases）.The CVVH group received routine CVVH therapy and the CVVH＋PE group received extra PE treatment.The indexes including myoglobin（Mb）、creatine kinase（CK）、CK-MB、lactate dehydrogenase（LDH）、serum creatinine（CREA）、blood urine nitrogen（BUN）and APACHEⅡscore in both groups were recorded and tested before and after therapy,and the data mentioned above were also recorded at the time of 24,48,72 hafter the therapy.All of the indexes were analyzed and compared intra and inter groups.Result：MB,CK,CK-MB,LDH,CREA,BUN and APACHEⅡscores indicated the therapeutic effect,and the levels of all factors decreased significantly in both groups after therapy 24、48、72h（P〈0.05）.Among them,MB、CK、CK-MB、LDH and APACHEⅡ scores decreased more significantly in CVVH＋PE group compared with CVVH group（P〈0.05）.Conclusion：CVVH combined with PE could improve the therapeutic effect more significantly than single CVVH treatment of CS.It is worth of being refered and applied in clinical practice.

关 键 词：血浆置换 连续静脉一静脉血液滤过 挤压综合征 

分 类 号：R642[医药卫生—外科学]