CVVHDF在老年患者多器官功能衰竭中的应用

目的观察连续性静脉-静脉血液透析滤过（CVVHDF）用于老年多器官功能衰竭（multi-ple organ failure in the elderly，MOFE）患者的临床疗效。方法15例MOFE患者，年龄63～87（72．9±5．6）岁。观察CVVHDF治疗前后患者SIRS指标（体温、心率、呼吸、动脉血二氧化碳分压及外周血白细胞总数）的改变，监测其肾功能、电介质、动脉血气、中心静脉压的变化。结果CVVHDF治疗后患者SIRS反应明显减轻，血管活性药物逐渐减量，13例机械通气患者6例成功撤离呼吸机，3例心跳呼吸骤停患者2例神志转清。血清尿素氮、肌酐、血钾较治疗前显著降低，低氧血症、酸中毒、心衰得到纠正，治疗前、后比较差异有显著性（P〈0．05）。结论CVVHDF治疗MOFE患者，可明显抑制患者SIRS反应，全面改善心肺脑肾功能，是MOFE患者重要的治疗手段之一。

Effects of continuous venovenous hemodiafiltration in gerontal patients with multiple organ failure

Objective To evaluate the clinical effects of continuous veno-venous hemodiafiltration (CVVHDF) on elder patients with multiple organ failure (MOFE). Methods Fifteen patients with MOF, aged 63-87 years old (average age was 72.9 ±5.6 years),were involved in this study. The clinical conditions of SIRS (including temperature, heart rate, respiratory rate, PaCO2 and peripheral leucocyte) were monitored after the initiation of CVVHDF. The renal function, electrolyte, blood gases, central venous pressure(CVP) were in-vestigated during CVVHDF. Results SIRS degrees in patients were all lightened after CVVHDF, vasoactive drugs were gradually raduced,6 of 13 patients were relieved of ventilator,2 of 3 patients became conscious from coma states, serum levels of urea,creatinine,electrolytes such as potassium were decreased after CBP. hypox-emia,oxidosis and heart failure were corrected (all P<0.05 compared with pre-therapy. Conclusion CVVH-DF can inhibit SIRS response in elder patients with MOF, rectify their heart and pulmonary function, keep bal-ance of electrolyte, help recover conscious from coma states.