日间高容量血液滤过在多脏器功能障碍综合征中应用的优势

目的探讨日间连续性高容量血液滤过在多脏器功能障碍综合征(multiple organ dys-function syndrome,MODS)中应用的安全性及治疗效果的评价。方法入选患者为安徽省立医院ICU2008年4月至2009年9月收治的MODS患者36例,随机将36例患者分为A组(持续标准容量血液滤过组,16例)和B组(日间高容量血液滤过组,20例)。比较两组血液净化的安全性和治疗效果,并以住ICU天数、28d无脏器衰竭天数、28d病死率作为预后指标,比较两组上述参数的差异。结果 B组与A组28d病死率分别为25.00%和31.25%,差异无统计学意义χ2=0.173,P=0.667);两组血液净化过程及血液净化后低血压发生率分别为15.00%和12.50%急性左心衰竭发生率分别为5.00%和6.25%,差异均无统计学意义(均P0.05)。B组住ICU天数较A组明显缩短分别为(8±5)d和(11±5)d,差异有统计学意义(t=2.30,P=0.029),28d内无脏器功能衰竭的天数明显增多分别为(18±8)d和(11±8)d,差异有统计学意义(t=2.21,P=0.036)。结论日间连续性高容量血液滤过在MODS的治疗中是安全高效的。

The application superiority of daytime continuous high-volume hemofiltration in patients with multiple organ dysfunction syndrome

Object To investigate the clinical effects and safety of daytime continuous high-volume hemofiltration in patients with multiple organ dysfunction syndrome （MODS） in ICU. Methods We recruited 36 patients with MODS treated in ICU during the period of April 2008 to Sept. 2009. Patients were randomly asigned into continuous normal-volume hemofiltration group （group A, n= 16） or daytime high-volume hemofiltration group （group B, n=36）. Mortality rate, critical care score, the days staying in ICU, and the days without organ failure within 28 days were compared between the 2 groups. Result There were no difference in mortality rate within 28 days between the 2 groups （25.0% in group A, and 31.25% in group B; χ^2=0.173, P=0.667）. In group A, however, the days without organ failure were longer （18±8 days in group A, and 11±8 days in group B; t=2.21, P=0.036）, and the days staying in ICU were shorter （8±5 days in group A and 11±5 days in group B; t=2.30, P=0.029）. Conclusion Daytime continuous high-volume hemofiltration is a safe and efficient method for the treatment of MODS in ICU.