羟乙基淀粉联合连续性血液净化治疗毛细血管渗漏综合征的临床研究

A clinical study on the therapy of hydroxyethyl starch and continuous blood purification for capillary leak syndrome

目的 探讨羟乙基淀粉（HES）和连续性血液净化（CBP）治疗毛细血管渗漏综合征（CLS）的疗效,以及使用羟乙基淀粉对患者预后的影响.方法 ICU收治的CLS患者101例,按照治疗措施不同分为：有、无使用HES组,有、无使用CBP治疗组,有、无使用HES联合CBP治疗组及治愈/好转组和死亡组;记录患者发生CLS时的临床资料,并进行急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）、简化急性生理学评分Ⅱ（SAPSⅡ）、多器官功能障碍综合征（MODS）评分,分析HES和CBP治疗的近期疗效及对患者预后的影响.结果 ①HES组患者病死率下降（P〈0.05）;②CBP组患者MODS评分较高（P〈0.05）,病死率无明显降低;③HES联合CBP组患者病死率也无明显降低;④死亡组患者APACHEⅡ评分、SAPSⅡ评分和MODS评分均较高（P〈0.01）.结论 CLS患者使用HES治疗可降低病死率,HES联合CBP组不降低患者的病死率;患者的病死率受病情危重程度影响较大.

Objective To investigate the therapeutic effect of hydroxyethyl starch （HES） and continuous blood purification （CBP） on capillary leak syndrome （ CLS）, and analyze the prognosis influenced by using HES. Methods According to the different treatment measures, the 101 cases with CLS in intensive care unit （ICU） were divided into： the using HES group and non using HES group, the using CBP group and non using CBP group, the using HES combined CBP group and no using HES or CBP group. According to the prognosis, they were divided into the survival group and death group. The clinical data were recorded when CLS occurred. And the second generation of acute physiology and chronic health evaluation （ APACHE II ）, the second generation of simplified acute physiology score （SAPS 11 ）, multiple organ dysfunction syndrome （MODS） score were calculated. The clinical therapeutic effect of HES and CBP, and their influence on the prognosis were discussed. Results （1）The mortality was decreased in the using HES group （ P 〈 O. 05 ）. （2）MODS scores was higher（ P 〈 O. 05）, and the mortality was not decreased in the using CBP group. （3） The fatality rate was not decreased significantly in the using HES combined CBP group. （4）The APACHE II score, SAPS II score and MODS score were higher in the death group（P 〈 0.01 ）. Conclusion The mortality of the patients with CLS is decreased by HES therapy, and is not decreased by HES combined CBP therapy. The fatality rate is greatly influenced by the critical condition of the patients with CLS.