连续性静脉-静脉血液透析在重症肾综合征出血热合并急性呼吸窘迫综合征治疗中的应用

目的探讨连续性静脉-静脉血液透析(CVVHD)在重症肾综合征出血热(HFRS)合并急性呼吸窘迫综合征(ARDS)治疗中的作用。方法 15例重症HFRS合并ARDS病人,其中男性11例,女性4例;年龄22~68岁,平均年龄45岁。在一般治疗、机械通气基础上采用CVVHD治疗,治疗前及治疗过程中检测血气指标(pH、氧分压、二氧化碳分压、氧分压/吸入氧浓度、氧饱和度)、肿瘤坏死因子(TNF-α)、白细胞介素6(IL-6)、白细胞介素10(IL-10),治疗前后检测肾功能。结果 15例病人存活12例,存活率80%(12/15)。治疗过程中血气指标平稳改善,治疗前后细胞因子TNF-α、IL-6、IL-10明显下降,肾功能改善明显。结论 CVVHD治疗可通过有效清除异常分泌的细胞因子改善ARDS,对HFRS合并ARDS有一定的治疗作用。

Application of continuous veno-venous hemodialysis in sever hemorrhagic fever with renal syndrome complicated by acute respiratory distress syndrome

Objective To evaluate the treatment effects of continuous veno-venous hemodialysis（CVVHD） in sever hemorrhagic fever with renal syndrome（HFRS） complicated by acute respiratory distress syndrome（ARDS）.Methods A total of 15 patients with HFRS complicated by ARDS were enrolled,male 11,female 4,aged 22-68 years old,mean age 45 years old.All of them underwent general treatment,mechanical ventilation and CVVHD for 12 hours.The levels of tumor necrosis factor α（TNF-α）,interleukin 6（IL-6） and interleukin 10（IL-10）,blood urea nitrogen（BUN）,serum creatinine（SCr）,pH,p（O2）,p（CO2）,p（O2）/FiO2 and SaO2 were detected in all patients before and after hemopurification.Results There were 12 of 15 patients survived,survival rate was 80 %（12/15）.The mean levels of BUN,SCr were steadily improved during a single 12 hours treatment with CVVHD（P 0.01）.The TNF-α,IL-6 and IL-10 were significantly decreased during a single 12 hours treatment with CVVHD（P 0.01）.The pH,p（O2）,p（CO2）,p（O2）/FiO2 and SaO2 were significantly improved during the treatment with CVVHD.Only 1 case had hypotension during the treatment with CVVHD.Conclusion It is demonstrated that CVVHD could effectively clear the serum BUN,SCr,TNF-α,IL-6 and IL-10,and improve ARDS.Ithas a therapeutic effectin treatmentofHFRS complicated by ARDS.