连续性血液净化治疗多脏器功能障碍综合征疗效观察

Effects of continuous blood purification in the rescue of MODS patients

目的:观察连续性血液净化(CBP)对多器官功能障碍综合征(MODS)的疗效及其影响因素。方法:回顾性分析86例经CBP治疗的MODS患者的临床资料,以及CBP平均治疗时间、治疗前后平均动脉压、血气、血生化指标及转归。结果:年龄33～89岁,平均66.5±13.5岁。所有患者在CBP治疗前均存在不同程度肾功能障碍,CBP治疗后均纠正了水、电解质及酸碱平衡紊乱并能保障营养供给。CBP治疗后平均动脉压显著升高(P<0.05),二氧化碳结合力显著改善(P<0.05),血肌酐、尿素氮水平显著降低(P<0.05)。生存21例,放弃治疗18例,病死率与脏器衰竭数目及年龄相关,83%死亡者年龄60岁以上并3个或3个以上器官衰竭。结论:CBP能明显改善MODS患者的血液动力学及血液生化指标,持续清除毒素,减轻水负荷,保障足够的营养支持,较快纠正酸碱平衡失调,使平均动脉压回升。CBP是救治重危患者的有效抢救措施,其治疗时机可能是影响MODS患者生存率的重要因素之一。

Objective：To investigate the effects of continuous blood purification（CBP） in the treatment of 86 critical patients retrospectively,and analyze the influencing factors of prognosis.Methods The critical patients were treated with CBP in Urumqi General hospital.The clinical data were collected including sex,age,original disease,number of organ dysfunction and complications.The technique and method of CBP,and the outcomes were also collected.Blood urea nitrogen （ BUN ） , serum creatinine （ Scr ） , kalium （ K＋ ） ,were compared before and after the treatment also.Results After the treatment,all patients＇ general state of health, water-electrolyte and acid base disorder were improved.The levels of BUN,Scr （All P 0. 05 ） , were all lower and the levels of CO2CP （P 0. 05） were higher than that of the pretherapy.Conclusion CBP has better curative effect on removing the toxin effectively, rapidly correcting the turbulence of water electrolyte and sour-alkali balance for patients. CBP is a very effective therapy and it can improve the prognosis of the patients who had MODS or other dangers..