不同置换量对连续性血液净化治疗多器官功能障碍综合征的影响

Effects of different displacement volumes on treatment of multiple organ dysfunction syndromes during continuous blood purification

目的：探讨不同置换量对连续性血液净化（CBP）治疗多器官功能障碍综合征（MODS）的影响。方法：将18例接受CBP治疗的MODS患者随机分为A组[置换液量〈35ml／（kg·h），6例]、B组[置换液量45ml／（kg·h），6例]和C[组置换液量〉60ml／（kg·h），6例]，在治疗前、治疗后24、48h分别评价患者的各项生命指标及实验室指标、多巴胺浓度变化，进行急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、简单急性生理评分Ⅱ（SAPSⅡ）、MODS评分；检测血浆中肿瘤坏死因子-α（TNF-α）水平。结果：CBP治疗后，各组体温、心率、尿素氮（BUN）均明显下降，多巴胺浓度减少，pH值增加（P〈0．01—0．05）；治疗24h后，B组、C组APACHEⅡ评分、SAPSⅡ评分、MODS评分、TNF-α水平均较治疗前明显下降（P〈0．01～0．05）；A组观察48h，未发现APACHEⅡ评分、SAPSⅡ评分、MODS评分、TNF-α水平明显变化。结论：CBP能有效改善MODS患者临床状况；45ml／（kg·h）以上置换量CBP对MODS患者更有利。

Objective ：To investigate the effects of different displacement volume on treatment of multiple organ dysfunction syndromes（MOBS） during continuous blood purification（CBP）. Methods：Eighteen patients with MOBS who would receive CBP were randomly divided into group A [displacement liquid 〈35 ml/（kg · h） ,n =6） ] ,group B[ displacement liquid 〈45 ml/（kg · h） ,n =6] and group C[ displacement liquid 〉60 ml/（ kg ·h）, n = 6 ]. Before and after C BP for 24,48 hours, their clinical and laboratory indexes were compared. The levels of acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） , simplified acute physiology score Ⅱ （ SAPS Ⅱ ） , MOBS score were evaluated. The levels of tumor necrosis factor - α （ TNF - α） were measured. Results ： Temperature, heart rate, BUN, dopamine levels declined and PH improved after CBP （ P 〈 0. 01 - 0. 05 ）. APACHE Ⅱ , SAPS Ⅱ , MOBS score and TNF -α level in group B and group C were significantly lower after 24 h CBP than those of pre - CBP（ P 〈 0.01 -0.05 ）. However,these scores and TNF - α level did not decreased in group A after 48 - hour CBP. Conclusion： CBP is effective for patients with MOBS, the volume of displacement liquid over 45 ml/（ kg·h） during CPB can more effectively improve the chnieal conditions.