连续性血液透析对多器官功能衰竭患者肾功能及血流动力学水平的改善  

Improvement of renal function and hemodynamics in patients with multiple organ failure by continuous hemodialysis

作　　者：刘莹[1] 陈畅[1] 刘辉[1] Liu Ying;Chen Chang;Liu Hui(Department of Emergrncy, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China)

机构地区：[1]大连医科大学附属第一医院急诊科,大连116011

出　　处：《中国急救复苏与灾害医学杂志》2019年第10期953-956,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：辽宁省高等学校基本科研项目(LQ2017022).

摘　　要：目的分析连续性静-静脉血液透析滤过(continuous static-venous hemodialysis filtration , CVVHDF)对多器官功能衰竭患者肾功能及血流动力学水平的改善。方法选取2017年8月-2018年12月大连医科大学附属第一医院收治的多器官功能障碍综合征(multiple organ dysfunction syndrome, MODS)患者86例,根据治疗方法不同均分为两组。对照组给予连续性静脉-静脉血液滤过(CVVH),观察组给予CVVHDF,分析两组患者治疗前、治疗24h后血流动力学指标、肾功能指标、免疫功能指标及急性生理和慢性健康状况Ⅱ(acute physiologicaland chronic health status Ⅱ,APACHE D )评分的变化情况。结果两组治疗前血流动力学指标、肾功能指标组间比较,差异不具有统计学意义(P>0.05);治疗24 h后平均动脉压(average arterial pressure, MAP)、心率(heartrate, HR)、肺动脉楔压(pulmonary artery wedge pressure, PCWP)、血肌酹、尿素氮水平较治疗前下降,心脏指数(heart index,CI)ZK平较治疗前上升(P<0.05)。两组治疗24 h后血流动力学指标、肾功能指标组间比较,差异不具有统计学意义(P>0.05).两组治疗前免疫功能指标水平及APACHE Ⅱ评分组间比较,差异不具有统计学意义(P>0.05),治疗24 h后辅助T细胞2(auxiliary T cell 2,Th2)水平及APACHE Ⅱ评分较治疗前下降,辅助T细胞1 (auxiliary T cell 1 ,Th1)、Th1/Th2比值较治疗前上升(P<0.05)。观察组治疗24 h后免疫功能指标.APACHEII评分优于对照组(P<0.05).结论CVVHDF应用于MODS患者可稳定血流动力学,改善免疫功能和肾功能,适合推广。Objective To investigate the effects of continuous intravenous hemodiafiltration (CVVHDF) on renal function and hemodynamics in patients with multiple organ dysfunction syndrome (MODS). Methods 86 patients with MODS were randomly divided into two equal groups.The control group was given continuous venous-venous blood filtration(CVVH), and the observation group was given CVV HDF. The changes of hemodynamics index, renal function index, immune function index and acute physiological and chronic health status II(APACHE II) score were analyzed in two groups. Results There was no significant difference in hemodynamic indexes and renal function indexes between the two groups before treatment (P<0.05). After 24 hours of treatment, the mean arterial pressure (Average arterial pressure, MAP), heart rate (Heart rate, HR), Pulmonary artery wedge pressure(PCWP), serum creatinine and urea nitrogen levels were lower than those before treatment, while the level of Heart Index(CI) was higher than that before treatment (P<0.05). There was no significant difference in hemodynamic indexes and renal function indexes between the two groups after 24 hours of treatment (P<0.05). There was no significant difference in the level of immune function indexes and APACHE U score between the two groups before treatment. 24 hours after treatment, the level of helper T cells 2 (Auxiliary T cell 2, Th2) and APACHE U score decreased compared with those before treatment, and helper T cells 1 (Auxiliary T cell 1, Th1). The ratio of Th1/Th2 were higher than those before treatment (P<0.05). the immune function index after 24 hours of treatment in the observation group, and the APACHE II score was better than those in the control group (P<0.05). Conclusion The application of CVVHDF in MODS patients stabilizes the hemodynamics, improve the immune function and renal function, and is suitable for popularization.

关 键 词：连续性静-静脉血液透析滤过 连续性静脉-静脉血液滤过 多器官功能障碍综合征 血流动力学 肾功能 免疫功能 

分 类 号：R459.5[医药卫生—治疗学]