多脏器功能衰竭患者应用连续性静-静脉血液滤过治疗的临床研究

Continuous veno-venous hemofiltration in the treatment of multiple organ dysfunction syndrome

目的观察分析MODS（多脏器功能障碍综合征）患者应用连续性静-静脉血液滤过治疗的疗效和对血流动力学的影响。方法选择我院由各种病因导致的MODS32例患者，全部病例均给予连续性静-静脉血液滤过（CVVH）治疗，并检测CVVH前、后血肾功能及电解质和动脉血气。利用美国BioZ 无创心脏动力学系统监测血流动力学改变。结果CVVH治疗过程中，患者APACHEII评分有下降趋势，并渐趋正常，与治疗前比较，差异有显著性（P〈0．05）。治疗前患者肾功能BUN、SCr和血清钾高，CVVH治疗后BUN、SCr和血清钾均明显降低。与治疗前比较，差异有显著性（P〈0．05）。治疗后血清钠趋于稳定，与治疗前比较，差异有显著性（P〈0．05）。CVVH治疗过程中，患者PH值渐趋正常，与治疗前比较，差异有显著性（P〈0．05）。治疗前患者氧合指数PaO2／FiO2低，CVVH治疗后与治疗前比较，差异有非常显著性（P〈0．01）CVVH24h后HR、MAP、LCWI、TFC、CO、SVR、CVP均有明显改善，TFC和SVR72h后逐渐趋向稳定，与CVVH前相比P〈0．01。结论CVVH可有效改善肾功能，调节酸碱和电解质平衡，患者的血流动力学稳定，有利于改善患者的预后。

Objective To investigate the efficacy of continuous veno-venous hemofihration （ CVVH ） in the treatment of multiple organ dysfunction syndrome （ MODS ） and the impact of this therapy on hemodynamics. Methods 32 patients with MODS who had undergone CVVH were included in this study. Heart rate （ HR ）, mean pulmonary arterial pressure （ MAP ）, central venous pressure （ CVP ）, left cardiac work index （ LCWI ）, cardiac output （ CO ）, systemic vascular resistance （ SVR ）, and thoracic fluid content （ TFC ） were measured with the BioZ Cardio Dynamics. Concentrations of BUN and SCr, and serum levels of potassium and sodium were detected before and after CVVH. Results Levels of BUN and SCr and serum potassium declined significantly 72 hours after CVVH （ P 〈 0.05 ）; and HR, MAP, LCWI, TFC, CO, SVR, and CVP decreased 24 hours after CVVH （ P 〈 0.05 ） and then became stable at 72 hours with amelioration of PaO2/FiO2 （ P 〈 0.01 ）. Conclusions Continuous veno-venous hemofihration can effectively improve renal function, regulate acid-base and electrolyte balance, and maintain stability of hemodynamics in patients; thus it is beneficial for improvement in prognosis.