ICU重症血液净化临床应用观察

Clinical application of critical care blood purification in ICU

目的:调查成人综合ICU患者重症血液净化应用情况,为血液净化治疗提供参考。方法:回顾2017-01-2018-12期间我院成人ICU血液净化61例患者的临床资料,分析患者的疾病种类、血液净化模式、抗凝方式,并讨论影响患者预后的相关因素。结果:①61例血液净化患者中,男35例,女26例,平均年龄(55.8±19.5)岁;②血液净化病种前5位分别为急性中毒(13例,21.3%)、急性肾功能衰竭(13例,21.3%)、脓毒症(12例,19.7%)、心功能衰竭(10例,16.4%)、多器官功能障碍综合征(5例,8.2%);③血液净化模式:持续静脉血液滤过及透析(CVVHDF)40例(65.6%)、血液灌流(HP)12例(19.7%)、持续静脉血液滤过(CVVH)5例(8.2%)、组合式3例(4.9%)、血浆置换(PE)1例(1.7%);④抗凝方式:持续普通肝素抗凝28例(45.9%)、无肝素16例(26.2%)、间断普通肝素13例(21.3%)、枸橼酸抗凝4例(6.6%);⑤死亡患者年龄、APACHEⅡ评分、使用血管活性药物、机械通气、院内感染发生率与抢救成功患者比较,均差异有统计学意义(P<0.05)。结论:①重症血液净化是ICU危重患者的重要抢救手段,广泛用于跨学科及多病种患者的救治;②患者预后与年龄、使用血管活性药物、机械通气、合并院内感染、APACHEⅡ评分密切相关。

Objective: To investigate the application of blood purification in adult comprehensive ICU patients and provide reference for blood purification treatment. Method: Clinical data of 61 patients with blood purification in adult ICU of our hospital from January 2017 to December 2018 were collected. Disease types, blood purification mode and anticoagulation modes of the patients were counted, and the influencing factors of death and successful rescued were analyzed. Result: ①Sixty-one patients with blood purification were 35 males and 26 females, with an average age of 55.8±19.5 years old. ②The top 5 diseases of blood purification diseases were 13 cases of poisoning(21.3%), 13 cases of acute renal failure(21.3%), 12 cases of sepsis(19.7%), 10 cases of heart failure(16.4%), and 5 cases of MODS(8.2%).③Blood purification mode: CVVHDF was used in 40 cases(65.6%), HP was used in 12 cases(21.3%), CVVH was used in 5 cases(8.2%), combined types were used in 3 cases(4.9%), TPE1 in 1 case(1.7%).④Anticoagulation methods:continuous ordinary heparin anticoagulation in 28 cases(45.9%), no heparin in 16 cases(26.2%), intermittent ordinary heparin in 13 cases(21.3%), and citrate anticoagulation in 4 cases(6.6%).⑤Age of the patients, APACHEⅡ score on admission, use of vasoactive drugs, the ratios of use mechanical ventilation, and incidence of nosocomial infection were significantly different from those who were successfully rescued from who died(P<0.05). Conclusion: ①Severe blood purification is an important rescue method for ICU critical patients, which is widely used in the treatment of interdisciplinary and multi-disease patients. ②Prognosis of patients with blood purification was closely related to age, use of vasoactive drugs, mechanical ventilation, comorbidity with nosocomial infection, and APACHE-Ⅱ score.