多器官功能障碍综合症患者应用CRRT临床研究

The study of the continuous renal replacement therapy on patients with multiple organ dysfunction

目的观察连续性肾脏替代治疗(CRRT)对多器官功能障碍综合症(MODS)的临床疗效。方法将我科(ICU)2007～2010年收治的多器官功能障碍综合症30例给予连续静-静血液滤过(CVVH)方式治疗,治疗前后检测肾功能、电解质、二氧化碳结合率(CO2-CP)、血浆肿瘤坏死因子a(TNF-a)、白介素1β(IL-1β)水平的变化。结果治疗后血尿素氮(BUN)、肌酐(SCr)、血清磷、血浆TNF-a、IL-1β水平较前下降明显(P<0.05),血清钾、钠、氯、钙及二氧化碳结合率水平无显著变化。结论连续肾脏替代治疗能够有效救治多器官功能障碍综合症,毒素清除能力强,能显著清除炎症介质、能保持水电及酸碱平衡。

Objective To observe the therapeutic effect of CRRT on patients with MODS.Methods Thirty hospitalized patients in ICU from 2007 to 2010 of MODS were treated by CRRT.All of the patients were indicated for the application of CVVH.Before and after each session of CVVH,serum level of urea,creatinine,CO2-combining power（CO2-CP）,and electrolytes such as potassium,sodium,calcium and chloride were evaluated.Plasma levels of TNF-a and IL-1β were measured by enzyme linked immunoassay（ELISA） before and after CRRT.Results Serum level of urea、creatinine、phosphonium and the plasma concentrations of TNF-a and IL-1β decreased significantly following CRRT（P0.05）.Serum electrolytes levels were maintained in stable range expect phosphonium.Conclusion CVVH is a good method for the treatment of MODS patients,its capability of toxin clearance is strong,it can clear inflammatory mediators efficiently,and can keep water-electrolyte and acid—base balance.