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时间:2020-05-14
《高容量血液滤过治疗多器官功能障碍综合征的临床分析.pdf》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、浙江临床医学2015年7月第17卷第7期高容量血液滤过治疗多器官功能障碍综合征的临床分析赵黎陈华茜刘巍张任阮华玲★【摘要】目的探讨高容量血液滤过(HVHF)治疗多器官功能障碍综合征(MODS)的疗效。方法选择MODS患者83例,随机分为HVHF~R(42例)和(连续性静脉血液滤过)CVVH~(4l例)。比较两组治疗24h、48h、72h后心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、pH值、氧合指数(PaO2/FiO2)、多巴胺剂量、SCr、BUN、、TNF—d、IL-10、CRP、APACHE1I评分、SOFA评分;并比较两组治疗
2、72h后的存活率。结果HVHF~-存活率76.19%,CVVH~-53.66%,两组比较差异有统计学意义(P<0.05);两组治疗24h后肾功能、电解质、酸碱失衡均得到纠正,组间差异无统计学意义(P>0.05);HVHF~-治疗24~48h/~PaO2/FiO2、MAP升高,HR、CVP、多巴胺剂量、TNF.、IL一10、CRP、APACHElI评分、SOFA评分下降(P<0.05),r~CVVH组出现相应变化较HVHF组晚(P<0.05)。结论HVHF和CVVH均能纠~MODS患者的内环境,但HVHF较CVVH~更早地改善MODS患者的血流动
3、力学、组织缺氧、APACHEII评分和SOFA评分,更有效的清除炎症因子,提高MODS患者的存活率。【关键词】高容量血液滤过多器官功能障碍综合征炎症因子【Abstract】ObjectiveToinvestigatetheeficacyofhighvolumehemofiltration(HVHF)inthetreatmentofmultipleorgandysfunctionsyndrome(MODS).Methods83patientswithMODSwererandomlydividedinto2groups:theHVHFgroup(n
4、=42)andtheCVVHgroup(n=41).ComparedthechangesofHR,MAP,CVP,PH,PaO2/FiO2,thedoseofDopamine,SCr,BUN,K+,TNF-0【,IL一10,CRP,APACHEII.SOFAscoresbetweenthe2groupsbeforeandafterthetreatmentat24、48、72hours.Thesurvivalratewascomparedat72h.ResultsThesurvivalratewas76.19%inHVHFgroupanditwa
5、s53.66%inCVVHgroup.therewerediferencesbetweenthe2groups(P<0.05J.Aftertreatmentfor24hours,theelectrolytesturbulenceandacid-basebalancewerecorrected,thelevelsofSCrandBUNweresignificantlydecreasedinbothgroupsandwithoutstatisticaldiferencesbetweenthe2groups(P>0.05).Aftertreatmen
6、tfor24to48hours,PaO2/FiO2andMAPweresignificantlyincreased,HR,CVP,doseofDopamine,TNF—,IL一10,CRP,APACHEII,SOFAscoresweresignificantlydecreasedinHVHFgroup(P<0.05),butthesehappenedlaterinCVVHgroup(P<0.05).ConclusionAlthoughbothHVHFandCVVHcanmaintaininternalenvironmentstable,HVHF
7、canamelioratebloodflowdynamics,improvethetissuehypoxia,decreaseAPACHEIIandSOFAscoresmuchearlierthanCWH.HVHFhasbetterabilitiesinremovinginflammatoryfactorsandimprovingsurvivalrateinMODSpatients.【Keywords】}nghvolumehemofiltrationMultipleorgandysfunctionsyndromeInflammatoryfact
8、ors作者单位:442008湖北医药学院附属东风医院通讯作者HT患者甲状腺细胞损伤的重要机制。TPO的自身免autoimrnunethyroiditi
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