连续性血液净化治疗多脏器功能障碍综合征22例临床观察

Observation of continuous blood purification on 22 patients with multiple organ dysfunction syndrome

目的观察连续性血液净化(continuous blood purification,CBP)治疗多器官功能障碍综合征(MODS)的临床疗效。方法 22例MODS患者进行床旁血液透析滤过(CVVHDF)治疗,观察患者治疗前后血压、心率、肾功能、电解质、动脉血气分析、C-反应蛋白(C-reactive protein,CRP)指标的变化及预后。结果 22例患者均可耐受治疗,治疗后血尿素氮(BUN)、血肌酐(SCr)、血清尿酸(UA)、CRP明显下降,电解质及酸碱平衡维持稳定,脱水量均可达预期目标。结论 CBP能有效救治MODS患者,其血流动力学稳定,毒素清除能力强,能维持水、电解质及酸碱平衡,减轻炎症反应。

Objective To observe the therapeutic effect of continuous blood purification on patients with MODS. Methods 22 hospitalized patients of MODS were treated by CBP, 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, phospbonium, chloride and CRP were evaluated. Results All the patients tolerated CVVHDF therapy well. Reduction rates of serum urea, creatinine, uric acid after CVVHDF were significant respectively. Serum electrolytes levels were maintained in stable range except phosphonium（ P 〈 0.01 ）. The plasma concentrations of CRP 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.