持续血液滤过治疗急性呼吸窘迫综合征合并多器官功能障碍综合征

Continuous high-volume hemofiltration treatment in patients with acute respiratory distress syndrome and multiple organ dysfunction syndrome

目的探讨持续高容量血液滤过(CHVHF)对急性呼吸窘迫综合征(ARDS)合并多器官功能障碍综合征(MODS)的疗效。方法将40例确诊ARDS合并MODS患者,按住院先后分治疗组21例,对照组19例,在同样的治疗基础上,治疗组加用CHVHF。观察治疗过程中患者生命体征,氧分压(PO2)、氧合指数(O I)、血肌酐(SCr)、C反应蛋白(CRP)、血谷丙转氨酶(ALT)的变化和最终的死亡率。结果CHVHF组患者治疗前后SCr、CRP、ALT和O I差异有显著性(P<0.05),对照组治疗前后只有O I差异有显著性(P<0.05)。两组相比治疗后SCr、CRP、ALT和O I差异有显著性(P<0.05)。对照组死亡13例,病死率68.4%;治疗组死亡8例,病死率38.1%,两组相比差异有显著性(P<0.05)。结论CHVHF治疗能迅速改善ARDS合并MODS患者的病情,显著降低死亡率。

Objective To evaluate whether continuous high-volume hemofiltration （ CHVHF） improves prognosis in patients with acute respiratory distress syndrome （ ARDS） and multiple organ dysfunction syndrome （ MODS）. Methods 40 patients with ARDS and MODS were divided into test group （21 patients） and control group （19 patients）. After all the patients in two groups received identical treatment, the test group were randomly assigned to 7-16 hours of CHVHF everyday. The changes in arterial oxygen pressure （ PO2 ） ,oxygenation index（ OI） ,serum creatinine （SCr）, C reactive protein （CRP） ,alanine aminotransferase （ALT） levels and fatality rate were measured. Results There were not different both in test group and control group before treatment. SCr, CRP, ALT and OI were improved significantly after CHVHF in test group （ P 〈 0. 05 ）. OI was improved significantly in test group compared with that in the control group after treatment （ P 〈0.05）. The motality was reduced significantly in test group（ 38.1%） compared with that in the control group （ 68.4% ） （ P 〈 0. 05 ）. Conclusion CHVHF can improve prognosis and reduce motality significantly in patients with ARDS and MODS.