多功能血液净化仪在危重患者治疗的临床观察

Clinical use of a multi-purpose blood purification instrument in the critically ill

目的：应用JH血液透析机的多功能性行PE、HP和CRRT治疗，并与进口血液透治疗进行比较，以探讨危重患者救治措施及方案选择。方法：102例患有ARF、SIRS、MODS、SAP、ARDS等危重症患者，根据治疗方式的不同分为：CAVHD（A组）；CAVHF或CAVHDF（B组）；及CAVHF或CAVHDF配合PE或HP治疗（C组）。对照组为条件相当的重症患者行HD治疗。结果：A、B、C3组及对照组治疗前后自身对照结果显示血清BUN、Cr、K^＋和PO4^3-均有明显降低（P〈0．001），血清C02CP显著升高（P〈0．01）；各组治疗前后cr和BUN下降幅度比较无显著性差异，与对照组相比差异均有显著性（P〈0．05）。CK、ALT、AST、LDH、和D-二聚体治疗前后比较在B组和C组均有显著降低（P〈0．01；P〈0．001），且C组患者CIC、CK、LDH、和D-二聚体的下降幅度较B组差异有显著性（P〈0．05）。各治疗组显效率和总有效率明显高于对照组，而死亡率和总无效率明显低于对照组。临床观察到，JH血液净化仪血流量和透析液流量稳定，监控精确，精确度和灵敏度很高，性能稳定，治疗过程中均未发现仪器相关的不良反应。结论：通过CRRT持续恒定地清除中小分子毒素、纠正水电解质酸碱平衡紊乱，并对于危重患者联合PE和HP可清除大分子毒素，可为一临床危重患者抢救提供更多的手段和措施。

Objective：To compare the use of JH Hemodialysis System in PE, HP and CRRT treatments with other imported products, so as to determine the rescue measures and options for critically ill. Methods ：102 cases of ARF, SIRS,MODS,SAP or ARDS were allocated to the following groups based on treatment options： CAVHD （Group A）, CAVHF/CAVHDF （Group B）, CAVHF/CAVHDF plus PE or HP （Group C）, compared with a clinically matched group （ control group） on HD treatment. Results ： Groups A, B and C experienced lower levels of serum BUN, Cr, K^ ＋ and PO4^3- （P 〈0.001 ） ,as well as higher level of serum CO2CP（P 〈0. 01 ） than did the control group. The reduction in Cr and BUN from baseline was comparable among non-control groups but different between non-control groups and the control group （ P 〈0. 05 ）. CK, ALT, AST, LDH and D-dimer in both Group B and Group C decreased significantly after treatment （P 〈0.01 ; P 〈0. 001 ） ; besides,the reduction degrees of CIC,CK,LDH and D-direct in Group C had significant difference when comparing with those of Group B （ P 〈 0.05 ）. Highly effective rate and total effective rate in each group were obviously higher, with their death rate and general ineffective rate distinctly lower than those of control group. In clinical observation, blood flux and dialysate flux by JH hemodialysis machine were stable. It monitored accurately with high sensitivity, and stable performance. No instrument related adverse reaction was observed during treatment. Conclusion： CRRT may continuously and constantly clear toxicity of middle molecule and micromolecule, and correct the disturbance of acid-base balance in water-electrolytes. Moreover, CRRT may be combined with PE and HP for clearing macromoleeule toxicity in critical patients,it provides more measures for saving critical cases clinically.