连续性血液透析滤过在多器官功能障碍综合症试验犬应用管理与效果观察

Administration and standardization monitoring of continuous Veno-Venous Hemofiltration in a canine model for multiple organ dysfunction syndrom

目的观察连续性血液透析滤过(CVVHDF)治疗在多器官功能障碍综合症(MODS)试验犬的治疗效果,探讨CVVHDFD管理措施在治疗MODS的效果,为临床患者CVVHDF的治疗管理提供依据。方法 15只Beagle犬采用失血性休克+复苏灌注+内毒素血症建立MODS模型,随机分为CVVHDF组(n=8)和MODS组(n=7)。内毒素注射完毕后CVVHDF组接受CVVHDF治疗12 h;MODS组未接受CVVHDF治疗。CVVHDF组实施系统管理,观察要点:观察CVVHDF治疗过程中试验犬生命指征的变化和重要脏器功能变化,实施心电监测,呼吸机辅助呼吸,保证机器正常运转,维持体外循环通道畅通,准确按时留取。结果 CVVHDF组8只试验犬的连续12 h的治疗均顺利完成,各主要器官功能明显改善,平均动脉压基本保持在正常水平,尤其在6、3、9、及12h时间点显著高于MODS组,差异均有统计学意义(P<0.01)。PaCO2逐渐升高与MODS组在3、6、9及12 h比较,差异均有统计学意义(P<0.01)。结论连续性血液透析滤过能明显改善内毒素诱导的低血压,提高动脉血氧分压;能改善主要脏器功能,稳定内环境。有效的CVVHDF管理措施,可以保证治疗的顺利完成,达到治疗预期目标。

Objectives To evaluate the effects of standardization monitoring during continuous veno-venous hemofiltration（CVVHDF） in multiple organ dysfunction score（MODS） canines,and to explore the practice effects of administration measures of（CVVHDF） in curing MODS canines.Methods Fifteen beagle dogs which were subjected to hemorrhagic shock plus resuscitation and endotoxemia to set up MODS model were divided randomly into two groups： 8 canines in CVVHDF group and administration measures were performed about 12 hours after endotoxemia was finished and 7 canines in MODS group CVVHDF and administration were not performed after endotoxemia was finished.The differences of blood pressure in two groups after and administration were analyzed by test.Results The blood pressures and PaCO-2 of 8 canines in CVVHDF group were higher than that of 7 canines in MODS group at 3rd hour,6th hour,9th hour and 12nd hour.The differences of blood pressure and PaCO-2 between CVVHDF group and MODS group after CVVHDF and administration showed significant variations（P0.01）.Conclusion With evidence-baced nursing（EBN） intervention,the incidence of hypotension in hemodialysis can be prevented efficiently.