连续性肾脏替代治疗救治多器官功能障碍综合征

Analysis of Continuous Renal Replacement Therapy(CRRT) on 20 Patients with Multiple Organ Dysfunction Syndrome(MODS)

【目的】观察连续性肾脏替代治疗(CRRT)救治多器官功能障碍综合征(MODS)的临床疗效及其对血浆炎症介质水平的影响。【方法】20例MODS患者给予连续性静-静脉血液透析滤过(CVVHDF)方式治疗,比较治疗前后APACHEⅡ评分及血清尿素氮(BUN)、肌酐(SCr)、尿酸(UA)及血清电解质钾、钠、氯、钙、磷及二氧化碳结合力的变化,检测CRRT前后血浆肿瘤坏死因子α(TNF-α)、白介素1β(IL-1β)水平的变化。【结果】20例患者均很好地耐受治疗,APACHEⅡ评分明显改善,治疗后BUN、SCr及UA下降率分别为(42±13)%(、36±9)%及(52±11)%,血清钾、钠、氯、钙及二氧化碳水平无显著变化,血磷水平明显下降(P<0.01)。CRRT治疗后血浆TNF-αI、L-1β水平显著低于治疗前(P<0.01)。【结论】连续性血液透析滤过能有效救治MODS患者,其血流动力学稳定,毒素清除能力强,能保持水、电解质及酸碱平衡。

[Objective]To observe the therapeutic effect of CRRT on patients with MODS,and to evaluate the influence on plasma level of inflammatory mediators.[Methods]Twenty hospitalized patients of MODS were treated by CRRT.All of the patients were indicated for the application of CVVHDF.Before and after each session of CVVHDF,serum level of urea,creatinine,uric acid,CO2-combining power（CO2 CP）,and electrolytes such as potassium,sodium,calcium,phosphonium and chloride were evaluated.APACHEⅡ score was assessed before and after the treatment and the prognosis of each patient was recorded as well.Plasma levels of TNF-α and IL-1β were measured by enzyme-linked immunoassay（ELISA） before and after CRRT.[Results]All the patients tolerated CVVHDF therapy well and APAHCE-Ⅱ score was lower.Reduction rates of serum urea,creatinine,uric acid after CVVHDF were（42±13）%、（36±9）% and（52±11）%,respectively.Serum electrolytes levels were maintained in stable range except phosphonium（P〈0.01）.The plasma concentrations of TNF-α and IL-1β decreased significantly following CRRT（P〈0.001）.[Conclusion]CVVHDF is a good method for the treatment of MODS patients,its capability of toxin clearance is strong,and can keep water-electrolyte and acid-base balance.It can clear inflammatory mediators efficiently.