高容量血液滤过在肝移植术后多器官功能障碍综合征患者中的应用

Application of High Volume Hemofilatration on Patients with Multiple Organ Dysfunction Syndrome after Liver Transplantation

【目的】探讨高容量血液滤过(HVHF)在肝移植术后因严重感染引起多器官功能障碍综合征(MODS)患者中的应用。【方法】分析2003年12月至2008年12月肝移植术后因感染引起MODS进行连续性血液净化治疗74例患者的临床资料,根据超滤率是否大于35 mL.kg-1.h-1分为HVHF组(49例)和连续性静脉-静脉血液滤过(CVVH)组(25例)。记录治疗前和治疗后24、48、72 h APACHⅡ评分、电解质、血流动力学和呼吸功能各项指标,以及临床转归。分别对组内治疗后各时间点与治疗前以及两组间各时间点之间的观察指标进行比较。【结果】HVHF组患者,APACHⅡ评分、乳酸、肌酐、心率、多巴胺用量、气道平均压和气道峰压、氧合指数等指标在治疗后24、48、72 h较治疗前明显下降(P<0.05)。CVVH组患者,APACHⅡ评分、乳酸、气道平均压和气道峰压值治疗前后无明显变化(P>0.05),心率、多巴胺用量和氧合指数虽较前有所改善,但程度均不如HVHF组(P<0.05)。HVHF组病死率为59.2%(29/49),CVVH组为84.0%(21/25),两者具有统计学差异(P=0.031)。【结论】HVHF通过维持机体内环境的稳定,为其他治疗创造有利条件,有助于提高肝移植术后危重患者的生存率。

[Objective] To investigate the effect of high volume hemofilatration （HVHF） in the patients with MODS induced by severe infection after liver transplantation. [Method] Seventy-four patients with MODS caused by severe infection after liver transplantation who have received continuous blood purification （CBP） from December 2003 to December 2008 were divided into two groups according to uhrafihration rate： HVHF group （49 patients） and CVVH group （25 patients）. APACH Ⅱ score, electrolyte, hemodynamic and respiratory- index were monitored pre and 24 h, 48, and 72 h post-CBP. [Results] APACH Ⅱ score, lactate （Lac）, creatinine （Cr）, heart rate （HR）, dopamine dosage, mean airway pressure （Pmean）, peak air pressure （Ppeak） and PaO2/FiO2 were improved significantly （P 〈 0.05） after treatment in HVHF group （49 cases）. There were no significant change （P 〉 0.05） of APACH Ⅱ score, Lac, Pmean and Ppeak between post and pre-treatment in CVVH group （25 cases）. Although Cr, HR, dopamine dosage, and PaO2/FiO2 were improved, but they were not as ameliorated as HVHF group （P 〈 0.05）. The mortality rate of HVHF group was 59.2%（29/49）, and that of CVVH group was 84.0% （21/25）. There was significant difference between them （P = 0.031）. [Conclusion] CBP can maintain internal environment stable, create lucrative condition for other treatment and help to increase the survival rate of the critical patients after liver transplantation.