连续静脉-静脉血液透析滤过治疗多器官功能障碍综合征的临床疗效研究

Clinical Effects of CVVHDF on the Patients with Multiple Organ Dysfunction Syndrome

目的:探讨连续静脉-静脉血液透析滤过(continuous veno-venous hemodialysis filtration,CVVHDF)治疗多器官功能障碍综合征(MODS)的临床疗效。方法:选择我院ICU自2015年1月-2017年2月收治的MODS患者50例作为研究对象,根据随机抽签原则分为观察组与对照组,每组25例。对照组在常规内科治疗基础上给予机械通气治疗,观察组在对照组基础上采用CVVHDF治疗,两组治疗观察时间为30d。观察和比较两组ICU停留时间、呼吸机辅助时间、治疗后APACHEⅡ评分与MODS评分、治疗前后血清IL-6与TNF-α含量的变化及随访6个月的死亡情况。结果:治疗后,观察组ICU停留时间和呼吸机辅助时间均短于对照组(P<0.05),APACHEⅡ评分与MODS评分分别为22.33±2.49分和6.42±1.98分,均明显低于对照组(62.19±7.45分和7.29±1.67分)(P<0.05)。治疗后,两组的血清IL-6与TNF-α含量都明显低于治疗前,且观察组的血清IL-6与TNF-α含量均明显低于对照组(P<0.05)。随访6个月,观察组与对照组的死亡率分别为4.0%和20.0%,观察组的死亡率低于对照组(P<0.05)。结论:CVVHDF治疗MODS能有效清除患者炎症因子,缩短ICU停留时间和呼吸机辅助时间,降低患者的死亡率。

Objective： To investigate the clinical effect of CVVHDF on the patients with multiple organ dysfunction syndrome（MODS）. Methods： 50 cases of patients with MODS in our hospital from January 2015 to February 2017 were selected as the subjects of study. All the patients were divided into the observation group and the control group with 25 patients in each group according to the principle of random ballot. The control group was treated with routine mechanical ventilation based on the routine medical treatment. The observation group was given mechanical ventilation and CVVHDF treatment on the basis of control group. The ICU standing time, ventilator assisted time, APACHEⅡ score and MODS score after treatment, the serum IL-6 and TNF-α content before and after treatment, the death status of two groups were observed and compared. Results： After treatment, the stay time of ICU and the time of ventilator assistance in the observation group were shorter than those in the control group（P〈0.05）. The APACHE II score and MODS score in the observation group were 22.33±2.49 points and 6.42±1.98 points, which were significantly lower than those of the control group（62.19±7.45 and7.29±1.67 points）（P〈0.05）. After treatment, the serum IL-6 and TNF-α in both groups were significantly lower than those before treatment, and the serum IL-6 and TNF-α in the observation group were lower than those in the control group（P〈0.05）. After a followed-up of6 months, the mortality rates in the observation group and the control group were 4% and 20%, respectively. The mortality of observation group was lower than that of the control group（P〈0.05）. Conclusion： CVVHDF could effectively eliminate the inflammatory factors in treatment of MODS, shorten the ICU retention time and the ventilator assisted time, and reduce the mortality of patients.