序贯性血液净化机治疗中毒所致的多器官功能障碍的临床效果及安全性评估  

Clinical efficacy and safety assessment of sequential blood purifier in the treatment of multiple organ dysfunction caused by poisoning

作　　者：徐静[1] 赵敏[1] 姜薇薇[1] 于蕾[1] 肖克来提·霍加合买提 Xu Jing;Zhao Min;Jiang Weiwei;Yu Lei;Xiaokelaiti•Huojia Hemaiti(Department of Emergency Intensive Care Unit,Emergency Trauma Center,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学第一附属医院急救创伤中心急救重症监护室,乌鲁木齐830000

出　　处：《中国医学装备》2024年第6期101-105,共5页China Medical Equipment

基　　金：新疆维吾尔自治区自然科学基金(2022D01C226)。

摘　　要：目的:研究序贯性血液净化机治疗中毒所致的多器官功能障碍的临床效果及安全性。方法:选取2020年5月至2022年2月新疆医科大学第一附属医院收治的110例中毒所致多器官功能障碍综合征(MODS)患者,采用随机数表法将其分为序贯性血液净化组和单种血液净化组,每组55例。对比两组患者在不同血液净化治疗下营养代谢指标、肠道屏障功能指标、急性生理与慢性健康量表(APACHEⅡ)评分、MODS早期预测评分系统及重症监护室(ICU)住院时间,同时记录不同血液净化治疗期间的并发症发生率。结果:两组治疗7d后,序贯性血液净化组患者的血红蛋白(Hb)、白蛋白(ALB)、胱抑素A(PAB)以及总胆固醇(TC)高于单种血液净化组,谷丙转氨酶(ALT)和甘油三酯(TG)均低于单种血液净化组,差异有统计学意义(t=4.454、4.474、13.22、2.035、51.358、2.195,P<0.05)。两组治疗7d后,钾离子(K+)及钠离子(Na+)差异无统计学意义(P>0.05)。序贯性血液净化组治疗7d后谷氨酸水平及谷氨酰胺水平高于单种血液净化组,尿乳果糖/甘露醇(L/M)比值低于单种血液净化组,差异有统计学意义(t=32.83、3.435、4.132,P<0.05)。序贯性血液净化组治疗7d后APACHEⅡ评分、MODS评分低于单种血液净化组,ICU住院时间短于单种血液净化组,差异有统计学意义(t=4.438、4.481、7.421,P<0.05),血液净化治疗并发症发生率低于单种血液净化组,差异有统计学意义(χ^(2)=5.238,P<0.05)。结论:序贯性血液净化治疗相比于单种血液净化治疗,在中毒所致的多器官功能障碍综合征治疗中可更好的促进调节机体营养代谢指标,改善肠道屏障功能,康复效果更好,并发症发生率较低,同时缩短了ICU住院时间。Objective:To explore and analyze the clinical efficacy and safety assessment of sequential blood purifier in the treatment of poisoning-induced multiple organ dysfunction syndrome(MODS).Methods:From May 2020 to February 2022,a total of 110 patients with MODS caused by poisoning who admitted to the First Affiliated Hospital of Xinjiang Medical University were selected.They were randomly divided into a sequential blood purification group and a single blood purification group,with 55 patients in each group.Nutritional metabolism indicators,function indicators of intestinal barrier,scores of Acute Physiology and Chronic Health Evaluation II(APACHE II),system of Multiple Organ Dysfunction Score(MODS)early prediction scores,and length of stay in Intensive Care Unit(ICU)between two groups were compared.At the same time,the incidence of complications during different blood purification treatments was also recorded.Results:After 7 days of treatment,the higher hemoglobin(Hb),albumin(ALB),cystatin A(PAB),and total cholesterol(TC)levels of sequential blood purification group were significantly higher than those of single blood purification group,while alanine aminotransferase(ALT)and triglycerides(TG)were significantly lower than that of single blood purification group(t=4.454,4.474,51.358,13.22,2.035,2.195,P<0.05),respectively.There were no significant differences in potassium(K+)and sodium(Na+)levels between the two groups after 7 days of treatment(P>0.05).Additionally,glutamate and glutamine levels of sequential blood purification group were significantly higher than those of single blood purification group,while L/M ratio was significantly lower than that of single blood purification group after 7 days of treatment,with statistically significant differences(t=32.83,3.435,4.132,P<0.05),respectively.The APACHEII score and MODS score of sequential blood purification group were significantly lower than those of single blood purification group,and the ICU length of stay was significantly shorter than that of single blood puri

关 键 词：中毒 多器官功能障碍综合征(MODS) 单种血液净化 序贯性血液净化 营养代谢 肠道屏障功能 并发症 

分 类 号：R459.7[医药卫生—急诊医学]