持续静-静脉血液滤过治疗在脑损伤合并严重感染患者中的应用观察

Observation of the application of continuous veno-venous hemofiltration in patients with cerebral injury complicated with severe infection

目的探讨静-静脉血液滤过（CVVH）在脑损伤中合并严重感染患者中的临床应用价值。方法回顾性分析2011年4月~2014年4月期间收入我院的57例脑损伤合并严重感染的患者分别采用CVVH联合药物治疗或常规药物疗法在改善临床症状及预后的比较结果。对比两组治疗前及治疗后各临床指标（体温、平均动脉压、白细胞计数、CRP、Pa O2/Fi O2、并发症出现情况）、APACHEⅡ评分及28 d死亡率。结果在年龄、性别、APACHEⅡ评分、器官衰竭数、机械通气率无明显差异情况下,应用CVVH治疗,其血清C反应蛋白（CRP）、白细胞计数、体温、28 d死亡率、与不行CVVH治疗组比较有明显差异。结论 CVVH改善脑损伤合并严重感染患者的临床症状,且采用无肝素抗凝并未明显增加患者的出血风险。应用CVVH能提高此类患者的抢救成功率。

Objective To explore the clinical application value of continuous veno-venous hemofiltration （CVVH） in patients with cerebral injury complicated with severe infection. Methods A total of 57 patients with cerebral injury complicated with severe infection who were admitted to our hospital from April 2011 to April 2014 were retrospectively analyzed. They were given CVVH combined with medicinal treatment or pharmacological method respectively. The im-provement of clinical symptoms and prognosis were compared. Each clinical index before and after the treatment （body temperature, mean arterial pressure, white cell count, CRP, PaO2/FiO2, conditions of complications）, APACHE II scores and 28-d mortality rate were compared between the two groups. Results Under the conditions that ages, gender, A-PACHEII scores, number of organ failure and the rate of mechanical ventilation were not significantly different, CVVH treatment was applied, and the serum CRP, white cell count, body temperature, and 28 d mortality were significantly different from those in the group who was not given the CVVH treatment. Conclusion CVVH improves the clinical symptoms of patients with cerebral injury complicated with severe infection, and anti-coagulation without heparin does not significantly improve patients＇ risk of bleeding. The application of CVVH is able to improve the successful rate of rescue for such type of patients.