连续性静脉-静脉血液滤过治疗八十岁以上老年多器官功能衰竭患者的经验

Effects of continuous veno-venous hemofiltration in gerontal patients with multiple organ failure

目的:观察连续性静脉静脉血液滤过(continuousvenovenoushemofiltration,CVVH)用于老年多器官功能衰竭(multipleorganfailureintheelderly,MOFE)患者救治的临床疗效,以及治疗中并发症的情况。方法:2000年至2004年在本中心接受CVVH治疗的35例MOFE患者,年龄80～94(84.1±4.08)岁。观察CVVH疗效及治疗过程中患者血压、心率、体温、呼吸等生命体征变化,监测其肝、肾功能,同时观察CVVH治疗中并发症情况。结果:35例患者中存活时间超过15天的有23例(65.7%),最终存活率为42.9%(15/35),13例肾功能恢复正常。存活组年龄明显低于死亡组[(85.1±4.11)岁vs(82.3±3.41)岁,P<0.05],同时呼吸衰竭及肝功能衰竭的发生率均明显低于死亡组,所有患者对CVVH治疗均耐受良好,治疗过程中血压、心律平稳,血流动力学稳定,存活组患者APACHEⅡ积分在治疗过程中明显下降。治疗中并发症发生率低,其中4例出现导管继发的感染,9例患者并发出血,4例患者体温不升,经积极处理后好转。结论:CVVH治疗用于MOFE患者的救治,可有效缓解患者病情,保护脏器功能,提高患者存活率,治疗过程中患者耐受良好,血流动力学稳定,并发症少,是MOFE患者救治中重要的治疗手段之一。

Objective:To evaluate the effects of continuous veno-venous hemofiltration (CVVH) in elder patients with multiple organ failure (MOF). Their clinical characteristics and the complications during CVVH were also observed. Methodology:Thirty-five patients with MOF, aged 80-94 years old (average age was 84.1±4.08 years), were involved in this study. The clinical conditions including blood pressure, heart rate, temperature and respiratory condition were monitored every hour, and the liver function and renal function were monitored after the initiation of CVVH. The complications were investigated during CVVH. Results:Of these 35 patients, 23 patients survived through 15 days after CVVH (15-days survival rate 65.7%), and finally 15 patients survived (survive rate 42.9%). Renal failure was presented in all patients before CVVH, and renal function recovered finally in 13 patients. CVVH was well tolerated in all of patients, who were maintained in a steady state of blood pressure and heart rate during CVVH. The APACHE Ⅱ score was decreased during CVVH in survival patients. The complications were bleeding in 9 cases, hypothermic in 4 and nosocomial infection in 4 cases during CVVH. Conclusion:CVVH therapy can get a high survive rate of 42.9% and 15-day survive rate of 65.7% in elder patients with MOF, which was well tolerated because of low complication rate.