持续高容量血液滤过在肾移植术后重症肺部感染中的应用

Effects of continuous high-volume hemofiltration on severe pulmonary infection in patients after kidney transplantation

目的探讨应用持续高容量血液滤过(CHVHF)对肾移植术后重症肺部感染患者临床疗效的影响。方法 2003年5月至2011年4月在我院行肾移植术后并发重症肺部感染的51例患者分为A、B两组,A组采用综合治疗结合持续高容量血液滤过(CHVHF)措施,B组采用常规的综合救治措施,未进行过持续高容量血液滤过治疗;比较两组患者在治疗前后同一时段的体温、心率、平均动脉压、血气变化以及两组患者病死率的情况。结果与B组常规治疗后比较,A组患者在体温、平均动脉压、血氧分压以及酸碱平衡有更明显的改善(P<0.05)。A组24例患者经治疗后22例痊愈出院2,例死亡,死亡率为8.33%;其中8例并发ARDS,有2例发展为MODS后死亡;B组27例患者经治疗后18例治愈出院,死亡9例,死亡率为33.3%;其中13例并发ARDS,有8例出现MODS,两组病死率差异有显著性(P<0.05)。结论持续高容量血液滤过是能有效地缓解症状,清除炎症介质,有助于重建机体免疫内稳状态,并提供稳定的血流动力学及水电解质平衡,帮助患者渡过危险期,从而为重症感染的救治创造条件。

Objective To evaluate the effects of continuous high volume hemofiltration（CHVHF） on severe pulmonary infection in patients after kidney transplantation.Methods Totally 51 patients with severe pulmonary infection following kidney transplantation were divided into group A and group B.Group A were received comprehensive treatment combined with CHVHF,while group B were given comprehensive treatment only.The temperature,heart beat,mean pulmonary pressure（MAP） and blood gas before and after the treatment were detected in both groups and the mortality rates were recorded.Results The body temperature,MAP,PaO2 and acid-base balance were better in group A compared with those in group B（P〈0.05）.Among the 24 patients in group A,22 patients were cured and 2 patients died,the mortality rate was 8.33%;8 patients developed adult respiratory distress syndrome（ARDS）,2 of them died.Among the 27 patients in group B,18 patients were cured and 9 patients died,the mortality rate was 33.3%;9 patients developed ARDS,8 patients developed multiple organ dysfunction syndrome（MODS）.The mortality rate between group A and group B was significantly different（P〈0.05）.ConclusionCHVHF therapy can improve the symptoms,reestablish the immune balance,keep stable blood flow dynamics and electrolyte balance and eventually provide better conditions for treatment.