血液净化与营养支持在救治老年多器官功能障碍综合征中的作用

<TITLE>THE EFFECT OF BLOOD PURIFICATION AND NUTRITIONAL SUPPORT ON THE MULTIPLE ORGAN DYSFUNCTION SYDROME IN THE ELDERLY

目的回顾性评价血液净化(bloodpurification)救治老年多器官功能障碍综合征(multipleorgandysfunctionsyndrome,MODS)伴肾功能衰竭(renalfailure,RF)中的作用,以及合适的营养支持方案。方法回顾了51例老年MODS伴RF患者的临床资料,将其分为三组:其中两组接受血液净化治疗:高蛋白组(蛋白质摄入2～2.5g·kg-1·d-1),正常蛋白组(蛋白质摄入1～1.2g·kg-1·d-1),另一组为非血液净化组(蛋白质摄入0.8g·kg-1·d-1)。比较各组的3个月生存率和生化参数。结果几乎所有的患者治疗前都存在低白蛋白血症。3个月生存率分别为高蛋白组41.7%、正常蛋白组20.7%、非血液净化组0.0%,各组相比P<0.01,有统计学意义。接受血液净化的两组对氮质血症的控制相对较好,而非血液净化组则控制不良。结论床边血液净化,特别是连续性血液净化技术(CBP)是MODS的基础治疗,同时应重视加强营养支持,尤其要提高蛋白质的摄入量,以达到正氮平衡,这样才能提高抢救成功率,延长生存时间。

Objective To assess the effect of blood purification on multiple organ dysfunction syndrome （MODS） associated with renal failure （RI7） in the elderly, and the optimum nutritional support during the therapy. Methods Clinical data of 51 elderly patients with MODS were reviewed. These patients were divided into three groups, two of them underwent blood purification： high protein gronp （protein intake 2-2.5g·kg^-1·d^-1）, normal protein group （protein intake 1-1.2 g·kg^-1·d^-1） and another non-blood purification group （protein intake 0.8 g·kg^-1·d^-1）. Their clinical results includi.ng 3-month survival rate and biochemical parameter were compared. Results Hypoalbuminemia was present in almost all cases before nutritional support. The 3-months survival rate was 41.7% in high protein group. 20.7% in normal protein group and 0% in non-blood purification group, respectively. It had significant that difference between these groups （P〈0.01）. The control of azotemia in high and normal protein groups was acceptable, whereas in non-blood purification group, it could not becontrolled. Conclusions Blood purification, especially continuous blood purification is a basal therapy in MODS. We suggest to strengthen nutritional suppart, especially increase protein administration in MODS in the elderly during the therapy, so as to maintain positive nitrogen balance and improve the success rate of resuscitation and prolong the survival time.