连续性高容量血液滤过治疗烧伤后多器官功能障碍综合征的临床观察

目的：探讨连续高容量血液滤过（CHVHF）治疗烧伤后多器官功能障碍综合征（MODS）患者的治疗效果。方法：回顾性分析16例接受CHVHF治疗的烧伤后MODS患者的临床资料。CHVHF治疗使用PRIS- MA机器及M100高通量血滤器,血管通路采用双腔中心静脉导管,抗凝使用低分子肝素或无肝素。置换液为前置换,流量4～4.5 L/h。测定治疗前后心率、体温、平均动脉压、氧饱和度、pH、氧合指数、肺泡动脉氧分压差、碳酸氢根、血肌酐、尿素氮,血钾、钠,氯,血乳酸等。结果：16例患者中存活7例。经CHVHF治疗后,患者血氧改善,血尿素氮、肌酐水平较治疗前明显降低。CHVHF治疗后体温、心率降低,血压升高。10例合并高钠血症和7例合并高乳酸血症的患者,血钠和血乳酸治疗前后比较差异显著（P〈0.01）。结论：CHVHF用于救治烧伤后MODS患者疗效确切,在清除毒素的同时,可提高肺换气功能,稳定水、电解质及酸碱平衡。

Clinical observation on therapeutic effect of continuous high volume hemofiltration in burn patients with multiple organ dysfunction syndrome

Objective:To observe the therapeutic effect of continuous high volume hemofiltration(CHVHF)in burn patients with multiple organ dysfunction syndrome(MODS).Methods:Data of 16 burn patients were ana- lyzed retrospectively.After confirmation of the diagnosis,a total of 16 burn patients with MODS had received CHVHF,with PRISMA machine,M100 high flexible dialyzer and double lumen catheters.Replacement solution infused rate was 4-4.5 L/h.Before and after CHVHF,levels of heart rate(HR),mean artery pressure (MAP),body temperature(T),percutaneous oxygen saturation(SpO_2),pH,HCO_3~-,partial pressure of oxygen in arterial blood/saturation of oxygen inspiration(PaO_2/FiO_2),blood urea nitrogen(BUN),serum creatinine (SCr),the difference of partial pressure of oxygen in arterial blood and alveo/i(P_(A-a)O_2),CO_2CP,tactic acid (LAC)and main biochemical parameters in plasma were measured.Results:Seven of 16 patients survived.After CHVHF,levels of HR,T,BUN,SCr,Na~ and LAC were obviously decreased(P<0.01).MAP.CO_2 CP were significantly higher compared to those before treatment(P<0.01).After CHVHF,the levels of Na~ and LAC were notably lowered in 10 patients with hypernatremia and 7 patients with hyperlaetacidemia(P<0.01).Conclu- sion:CHVHF plays an important role in the treatment of burn patients with MODS.which can remove toxin,im- prove the air exchange function of lung,and maintain a stable water-electrolyte as well as acid base balance.