连续性静脉-静脉血液滤过在高龄患者多器官功能衰竭中的应用

Application of continuous veno-venous hemofiltration to the treatment of multiple organ failure in senile patients

目的:观察连续性静脉-静脉血液滤过(CVVH)在高龄多器官功能衰竭(MOF)患者中的应用效果及安全性。方法:分析在床旁行CVVH治疗的16例高龄MOF患者,根据治疗后存活是否超过20 d分为存活组及死亡组。观察治疗前后肾功能、电解质、血气分析等指标、APACHEⅡ积分变化及并发症发生情况。结果:16例患者中存活时间>20 d者11例(68.8%),其中1例存活3年。治疗后患者血肌酐、尿素氮及血气分析结果显著改善。并发症发生少。治疗前,存活组APACHEⅡ积分明显低于死亡组。治疗后,存活组APACHEⅡ积分明显降低,而死亡组变化不大。结论:CVVH可有效缓解高龄MOF患者病情,延长存活时间,治疗中患者耐受良好,并发症少,是救治高龄MOF患者的重要手段之一。高APACHEⅡ积分患者预后不良。

Objective ： To evaluate the effect and safety of continuous veno-venous hemofiltration （CVVH） in the treatment of multiple organ failure （MOF） in senile patients. Methods： Sixteen patients with multiple organ failure, aged over 80 years, were divided into a survival group, who lived more than 20 days, and a non-survival group, less than 20 days after CVVH, and observed for such clinical indexes as of renal function, K^ ＋ and blood gas analysis, APACHEⅡ scores and complications. Results ： After CWH, eleven of the patients survived for over 20 days, with 1 case up to 3 years. CWH effected a significant improvement in BUN, Scr, K^＋ and blood gas as well as a marked reduction in complications. APACHE Ⅱ scores decreased significantly after CWH in the survival group though not in the non-survival group, as compared with those before CWH, which were significantly lower in the former than in the latter. Conclusion： CVVH is a safe, effective and well-tolerated method for the treatment of MOF in senile patients. Patients with higher APACHEⅡscores have a poor prognosis.