高容量血液滤过治疗多器官功能障碍合并脑水肿的作用  

Effects of high volume veno-venous hemofiltration on MODS with cerebral edema

作　　者：黄东健[1] 徐如祥[1] 唐新兴[1] 徐仲[1] 陈次滨[1] 

机构地区：[1]广州医学院附属广州市第二人民医院中心ICU,广东广州510150

出　　处：《国际医药卫生导报》2004年第8期4-7,共4页International Medicine and Health Guidance News

基　　金：广东省医学科研立项资助课题(项目编号:A2002589)

摘　　要：目的 探讨高容量静脉静脉血液滤过(HV-CVVH)治疗合并严重脑水肿的多器官功能障碍(MODS)的临床效果。方法 23例严重脑水肿(GCS评分5～6分)同时存在MODS但无合并肾功能衰竭患者(APACHEⅡ评分19～26)分为两组:HV-CVVH组(12例),血流量为250～300ml,置换液为3.0～4.0L/h;对照组(13例)按常规治疗。持续监测生命体征,检测血气分析和细胞因子。结果 HV-CVVH组治疗期间无死亡,与对照组比较,治疗后4～6小时平均动脉压开始显著上升,多巴胺输注速度减少,电解质和酸碱平衡维持在正常水平,氧合指数(PO2/FiO2)显著上升,血浆乳酸、IL-1β、IL-6、TNF-α水平较对照组显著下降(P<0.05～0.01),GCS和APACHEⅡ评分显著改善。三周后生存率比较,HV-CVVH组10例(10/12,83.3%),对照组5例(5/13,38.5%)。结论 高容量静脉静脉血液滤过(HV-CVVH)治疗MODS合并严重脑水肿有良好效果,这与其能较好地调节内环境、清除体内细胞因子和乳酸等炎性介质,改善的血流动力学、氧合功能有关。Objective To investigate the effect and possibility of high volume veno-venoushemofiltration (HV-CVVH) in multiple organ dysfunction syndrome (MODS) complicated with severe cerebraledema.Methods A total of 23 inpatients with MODS(APACHE II score 19～26) and severe cerebral edema(GCS 5～6), without renal failure were divided into two groups. HV-CVVH group(n=12) underwent high volumehemofiltration, the infusion rate of replacement fluid was about 3.0～4.0L/hr and the blood flow wasabout 250～300ml/hr. The control group(n=13) was deal with common method. During the treatment, Vitalsigns were continue monitored, blood gas analysis, cytokine in plasma were measured. Results none diedduring the course of treatmemt in HV-CVVH group.There was a significant increase in mean arterialpressure (MAP) and a drop in infusion rate of vasoactive drugs after 4 hour HV-CVVH treatment.Comparedwith the control group, it is to maintain in the normal scope in serumacid-base balance, while asignificant increase in PO2/FiO2 and a decrease in plasma Lactic Acid, IL-1β, IL-6, TNF-αwere found,GCS and APACHEⅡwere significantly improved. Survival rate after 3 weeks, HV-CVVH group 10 cases(10/12,83.3%), the control group 5 cases(5/13,38.5%). Conclusions High volume veno-venous hemofiltrationcan be technically possible in MODS complicated with severe cerebral edema patients, by which enhancedclearance of cytokines, lactic Acid, improved hemodynam and Stabilized internal environmen can beachieved.

关 键 词：血液滤过 脑水肿 多器官功能障碍 细胞因子 治疗 HV-CVVH 

分 类 号：R459.7[医药卫生—急诊医学]