摘要
目的探讨连续血液净化(continuous blood purification,CBP)对HELLP综合征(hemolysis,elevated liver enzymes,and low platele syndrome)合并多脏器功能障碍综合征(multiple organ dysfunction syndrome,MODS)的救治效果。方法回顾性分析蚌埠医学院第一附属医院重症医学科收治的HELLP综合征合并MODS患者15例,在及时终止妊娠,内科常规综合治疗的基础上,加用CBP治疗。记录患者APACHEⅡ评分、心率、呼吸、平均动脉压(MAP)、氧合指数、乳酸脱氢酶(LDH)、转氨酶、血清总胆红素(TBIL)、血小板计数等各项理化指标,比较入科时、住院期间峰值和出科时上述指标的变化;同时分析患者平均ICU住院时间、机械通气时间和CBP次数。结果 15例患者中,治愈12例,CBP平均次数(4.2±1.6)次、机械通气时间(4.9±2.1,n=9)d、ICU住院时间(7.3±2.3)d;患者入科时各脏器功能指标较差,住院期间又进一步加重直至达到最高峰,经过连续CBP治疗,患者神志转清、呼吸平稳、正常饮食,逐步消除了头痛头晕、视物模糊、黄疸恶心、出血及少尿等临床症状;各种理化指标比入科时和峰值均有较大程度的好转,差异均有统计学意义(P<0.05),TBIL、血尿素氮(BUN)、血肌酐(Cr)等下降明显,LDH、凝血酶原时间(PT)、肝酶、血小板计数恢复较快,贫血得到纠正,平均动脉压恢复正常;APACHEII评分在出科时(12.1±9.8)与入科时(21.9±8.7)和住院期间峰值(32.5±6.4)比较,差异均有统计学意义(P<0.05)。结论包括CBP的联合治疗能够改善患者的临床症状,逆转迅速恶化的各项理化指标,提高治愈率,是救治HELLP综合征合并MODS患者的有效手段。
Objective To investigate the effect of continuous blood purification (CBP) for the treatment of hemolysis,elevated liver enzymes and low platelet syndrome (HELLP syndrome) combined with multiple organ dysfunction syndrome (MODS).Methods We retrospectively analyzed 15 HELLP syndrome combined with MODS patients.These patients were treated with CBP in addition to termination of pregnancy,comprehensive treatment,and intensive medical care.APACHE score,HR,RR,MAP,oxygenation index,LDH,ALT,total bilirubin,and platelet count were measured.These parameters were compared at admission,disease peak and discharge from ICU.The average day treated in ICU,duration of mechanical ventilation,and CBP times were analyzed.Results Twelve of the 15 patients recovered.CBP was used for 4.2±1.6 times,and mechanical ventilation for 4.9±2.1 days (n=9); the average duration treated in ICU was 7.3±2.3 days.Patients at admission had poor organ function,which deteriorated to the disease peak during staying in ICU.After CBP,patients turned to have clear consciousness,steady respiration,normal diet,and improvement of headache,dizziness,blurred vision,nausea,jaundice,bleeding and oliguria (P<0.05).At the same time,total bilirubin,BUN,Cr,LDH,liver enzymes decreased,prothrombin time,platelet count,anemia and MAP recovered,and APACHE Ⅱ score reduced (21.9±8.7 at admission,32.5±6.4 at disease peak,and 12.1±9.8 at discharge from ICU; P<0.05).Conclusion Comprehensive therapy combined with CBP was an effective measure for HELLP syndrome patients combined with MODS.After the treatment,clinical symptoms improved,the rapid deterioration of physical and chemical indicators reversed,and the recovery rate increased.
出处
《中国血液净化》
2013年第11期608-611,共4页
Chinese Journal of Blood Purification
基金
安徽省"十二五"临床重点培育专科建设项目(编号:01P44)
关键词
连续血液净化
HELLP综合征
多脏器功能障碍综合征
Continuous blood purification
Hemolysis, elevated liver enzymes and low platelet syndrome (HELLP syndrome)
Multiple organ dysfunction syndrome