连续性血液净化对多脏器功能障碍综合征患者凝血功能的影响

目的探讨连续性血液净化治疗（continuous blood purification，CBP）对多器官功能障碍综合征（multiple organ dysfunction syndrome，MODS）凝血功能的影响。方法MODS患者39例，其中男21例，女18例，年龄40—97岁，均符合MODS诊断标准；予高容量连续性静脉-静脉血液滤过（high volume continuous venovenous hemofiltration，HV-CVVH）模式治疗；于CBP前、CBP开始后4、12、24、48、72h及CBP结束后6、24h测定心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、心排血量指数（cardiac index，CI）、氧合指数（PaO2／FiO2）、凝血酶原时间（prothmmbirtime，PT）、部分凝血酶原时间（activated partial thromboplast in time，APTT）、纤维蛋白原（fibrinogen，HB）及血小板（platelet count，PLT）变化；治疗后24、48、72h行急性生理功能和慢性健康状况（APACHEⅡ）评分，同时以未行CBP治疗的MODS患者25例作对照。结果与CBP前比较，PaO2／FiO2、CI在CBP开始后4h明显升高（P〈0．05）；CBP治疗组患者机械通气及血管活性药物使用时间明显缩短（P〈0．05），APACHEⅡ评分及病死率均有下降（P〈0．05），但低分子肝素抗凝组与无肝素组之间差异无统计学显著意义（P〉0．05）。结论CBP能改善血流动力学，改善氧合功能，维持患者凝血-纤溶系统的平衡，从而起到防治MODS的作用。

Effects of continuous blood purification on coagulation function in patients with multiple organ dysfunction syndrome

Objective To investigate the effects of continuous blood purification（CBP） on coagulation function in patients with multiple organ dysfunction syndrome （MODS）. Methods Thirty-nine patients with MODS （21 males, 18 females）aged 40 - 97years received CBP. All patients met the criteria of MODS. High volume continuous venovenous hemofihration （HV-CVVH） was performed. MAP, HR, CVP, cardiac index, PaO2/FIO2 , PT, APTT, FIB, PLT were measured and recorded before （baseline）and at 4,12,24,48 h and 72 h after CBP. APACHE Ⅱ score were recorded before （baseline）and at 24,48 h and 72 h after CBP. There was control group which composed of twentyfive patients with MODS treated with conventional methods without CBP. Results Compared with the baseline values before CBP PaO2/FiO2 and cardiac index were significantly increased at 4 h after CBP （ P 〈 0. 05 ）. The time of mechanical ventilation and the use of vasoactive agents were decreased in group with CBP treatment （ P 〈 0. 05 ）. APACHE Ⅱ score were significantly decreased after CBP（ P 〈 0. 05 ）. There was no significant change between low-molecular-weight heparin group and group without heparin （ P 〉 0. 05 ）. Conclusion CBP can improve hemodynamics and oxygenation function, keep the balance of the eoagulation-fibrinolysis system, so that CBP therapy is effective for patients with MODS.