杂合血液净化技术在心脏手术后的疗效观察  

Observation of Clinical Efficacy of Hybrid Blood Purification Technology after Cardiac Surgery

作　　者：孙凌霜[1] 刘淼淼[2] 薛瑾虹 何荃[1] 薛小红[1] 蒋红利[1] SUN Lingshuang;LIU Miaomiao;XUE Jinhong(Department of Blood Purification,Nephrology Hospital,The First Affiliated Hospital of Xi′an Jiaotong University,Shaanxi 710061,China;不详)

机构地区：[1]西安交通大学第一附属医院肾脏病医院血液净化科,710061 [2]西安交通大学第一附属医院肾脏病医院心血管外科,710061

出　　处：《医学研究杂志》2023年第9期113-118,共6页Journal of Medical Research

基　　金：陕西省社会发展攻关计划项目(2020SF-120);西安交通大学2019年临床新技术项目(XJLS-2019-008);西安交通大学第一附属医院2019年院级新医疗新技术项目(XJYFY-2019N18)。

摘　　要：目的探讨杂合血液净化技术在心脏手术后的临床疗效。方法选取半量血浆置换+双重血浆分子吸附+连续静脉-静脉血液滤过治疗施行体外循环心脏手术后患者,观察治疗前后血尿素氮、血肌酐(serum creatinine,Scr)、肝酶、胆红素、C反应蛋白(C reactive protein,CRP)等的变化情况,及随访治疗后3个月、6个月、1年的肝功能、肾功能及存活率。结果本研究最终纳入15例患者,共计28次治疗;杂合血液净化第2次治疗后96h Scr、天冬氨酸氨基转移酶(aspartate aminotransferase,AST)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、肌酸激酶(creatine kinase,CK)、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)与术前比较,差异均无统计学意义(P>0.05);第2次治疗后0h总胆红素(total bilirubin,TBIL)、直接胆红素(direct bilirubin,DBIL)、间接胆红素(indirect bilirubin,IBIL)、降钙素原(procalcitonin,PCT)、CRP与术前比较差异均无统计学意义(P>0.05);血小板治疗后持续降低;治疗后1年,患者存活率为80%。结论心脏手术后多脏器衰竭的患者应用杂合血液净化技术较理想,可以有效提高患者的生存率。Objective To investigate the clinical effect of hybrid blood purification technique after cardiac surger.Methods Patients undergoing cardiopulmonary bypass cardiac surgery were selected for half plasma exchange+double plasma molecular adsorption+continuous venous-venous hemofiltration therapy,the changes of blood urea nitrogen,serum creatinine(Scr),liver enzymes,bilirubin,C reactive protein(CRP)were observed before and after treatment,and the liver function,renal function and survival rate were followed up at 3months,6months,and 1 year after treatment.Results Fifteen patients were finally included in this study,with a total of 28 treatments.There were no statistical difference in the level of Scr,aspartate aminotransferase(AST),alanine aminotransferase(ALT),creatine kinase(CK)and creatine kinase isoenzyme(CK-MB)at 96h after the 2nd treatment of hybrid blood purification compared with those before surgery(P>0.05);there were no statistical difference in the level of total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),CRP and procalcitonin(PCT)at 0h after the 2nd treatment compared with those before surgery(P>0.05).Platelets continue to decrease after treatment.One year after treatment,the survival rate of patients was 80%.Conclusion The application of Hybrid blood purification technology is ideal for patients with multiple organ failure after cardiac surgery,which can effectively improve the survival rate of patients.

关 键 词：杂合血液净化 体外循环 心脏手术 多脏器衰竭 

分 类 号：R459.5[医药卫生—治疗学]