连续性血液滤过治疗老年性急性心肌梗死后合并多器官功能障碍综合征

Effect of continuous hemofiltration for treatment of multiple organ dysfunction syndrome after acute myocardial infarction in elderly patients

目的探讨持续血液滤过(CH)对老年性急性心肌梗死(AMI)后合并多器官功能障碍综合征(MODS)患者预后的影响。方法分析送入监护室治疗的AMI后合并MODS的老年患者34例,根据是否行CHF治疗分为CH组及非CHF组(NCH),观察并比较治疗前、治疗7d时两组患者APACHEⅡ评分及Marshall评分变化,并比较两组患者28d死亡率及90d死亡率。结果两组患者治疗前APACHEⅡ评分及Marshall评分无显著差异,而治疗7d后CH组APACHEⅡ评分及Marshall评分均较治疗前显著降低(分别P<0.05、P<0.01),而NCH组APACHEⅡ评分较治疗前显著增高(P<0.01),Marshall评分则变化不大(P>0.05)。28d总病死率、90d总病死率分别为41.18%、61.76%,而CH组、NCH组28d病死率有显著差异(P<0.05);而两组90d病死率无显著差异(P>0.05)。结论 CH可改善老年性AMI后合并MODS患者器官功能状态及短期预后,但对其长期预后无改善作用。

Objective To study the effect of continuous hemofiltration （CH） on the prognosis of multiple organ dysfunction syndrome （MODS） after acute myocardial infarction （AMI） in elderly patients. Methods Thirty-four elderly patients with MODS after AMI admitted to intensive care unit （ICU） were grouped into continuous hemofiltration （CH） group and non-CH （NCH） group. The Acute Physiology and Chronic Health Evaluation （APACHEII） scores and Marshall scores were assessed upon admission in ICU and 7 days after the admission. The mortality rates of the patients within 28 and 90 days after admission to ICU were calculated, and the changes in APACHEII scores and Marshall scores were compared between the two groups. Results The APACHEII scores and Marshall scores showed no significant difference between the two upon admission to the ICU, but significantly decreased in CH group 7 days after the admission （P〈0.05 and P〈0.01 respectively）. The APACHEII scores increased significantly in NCH group （P〈0.01） 7 days after the admission while the Marshall scores remained unchanged （P〉0.05）. The overall mortality rates at 28 and 90 days were 41.18% and 61.76%, respectively. A significant difference was noted in the mortality rate at 28 days between the two groups （P〈0.05）, but not in the rate at 90 days （P〉0.05）. Conclusion CH can improve the organic functions and the short-term outcome of elderly patients with MODS after AMI, but has no positive effect on their long-term outcomes.