持续血液净化在热射病合并多器官功能障碍综合征治疗中应用

目的探讨持续血液净化（CBP）对热射病（HS）合并多器官功能障碍综合征（MODS）治疗效果。方法选择2005年5月～2009年8月HS合并MODS患者11例,其中男性10例,女性1例,年龄17～25岁。每次治疗24～48h,置换液以前稀释方式输入,流量为2～4L/h,血流量150～250mL/min,采用普通肝素抗凝,而对于部分严重出血倾向患者,在给予补充血小板、凝血酶原复合物、纤维蛋白原等凝血底物的同时给予小剂量肝素抗凝。结果11例患者中9例痊愈出院,2例死亡;CBP治疗中患者血流动力学保持相对稳定,平均动脉压、心率和氧合指数均有所改善,多巴胺剂量逐渐减少（P〈0.05）,急性生理学及慢性健康状况（APACHEⅡ）评分降低（P〈0.05）;血中肌酐、尿素氮、肌红蛋白、肌酸激酶下降明显（P〈0.05）,但胆红素无明显变化（P〉0.05）;治疗中未发现明显副作用。结论CBP对HS合并MODS患者有改善预后的作用,患者耐受性好,是抢救HS合并MODS患者有效手段之一。

Application of continuous blood purification in heat stroke complicated with multiple organ dysfunction syndrome

Objective To study the treatment effect of continuous blood purification(CBP) on heat stroke(HS) patients complicated with multiple organ dysfunction syndrome(MODS).Methods From May 2005 to August 2009,11 patients of HS with MODS were performed CBP(male 10,female 1,aged 17-25 years).The times of CBP were 24-48 hours .The ultrafiltration rate during CBP was 2-4 L/h and blood flow was 150-250 mL/min.Normal heparin was used as anticoagulant.The platelet,prothrombin complex and fibrinogen had prescribed for pat...