连续性静脉静脉血液滤过治疗海洛因中毒及横纹肌溶解致急性肾衰竭1例

横纹肌溶解（rhabdomyolysis，RM）是指在创伤、缺血、代谢异常、药物和毒素作用下肌纤维坏死崩解，细胞内容物释放人血引起的一组临床综合征。严重的RM可导致急性肾衰竭（acuterenal failure，ARF），预后恶劣。我科使用连续性静脉静脉血液滤过（continuous venovenous hemofiltration，CVVH）成功抢救海洛因中毒、RM致ARF1例，报道如下。     

连续性静脉静脉血液滤过治疗严重高山病致多器官功能衰竭一例

人类若未经充分适应迅速上升至高海拔地区会出现急性高山病（AMS）,甚至并发多器官功能衰竭（MODS）,病死率极高。本文介绍我院使用连续性静脉静脉血液滤过（CVVH）成功抢救AMS致MODS 1例。     

连续性静脉-静脉血液滤过串联血液灌流治疗多器官功能障碍综合征

多器官功能障碍综合征(muhiple organ dysfunction syndrome，MODS)是严重感染、创伤、休克或中毒等因素诱发后，同时或序贯出现两个或两个以上器官系统功能障碍的综合征。随着医学科学的发展，单个脏器衰竭的治愈率普遍得到了提高，MODS对人类健康的威胁便日益显露，已经是危重病患者死亡的重要原因之一。文献报道合并两个脏器功能障碍的死亡率达50％～60％，4个或4个以上的死亡率几乎达100％，因而治疗MODS的最好方法就是预防，而预防应从其可能的发病机制和病理生理变化等方面着手。     

连续性静脉－静脉血液滤过治疗尿毒症并发高钾血症及严重心律失常一例

患者为高龄男性,尿毒症,长期血透,因胸痛3 h入院.体查:血压77～90/40～65 mm Hg,心律波动于30～200次/min,肌钙蛋白1+,心肌酶谱有动态变化.心电图示Ⅲ度房室传导阻滞与心动过速交替.     

连续性静脉-静脉血液滤过治疗重症颅脑疾病并高钠血症一例

患者，男，77岁。2003年12月10日因突发昏迷并致头部外伤半小时入院。短暂意识转清后又陷人深昏迷。BP170／90mmHg，生理、病理反射均消失，GCS评分3分．电解质正常，CT示双侧额叶及蛛网膜下腔出血，左侧颞顶硬膜下出血(56m1)。诊断：急性出血性脑血管病并颅脑损伤。立即行“颅内血肿清除 去骨瓣减压 右额板钻孔引流术”。     

横纹肌溶解综合征致急性肾衰竭一例

横纹肌溶解综合征（RM）是因各种原因引起骨骼肌急性破坏和溶解、细胞内容物释放并进入血液循环、导致体内电解质紊乱、代谢性酸中毒、低血容量、肌红蛋白尿等多种器官功能障碍综合征,以急性肾衰竭（ARF）最多见。现将我院近期收治的RM-ARF患者1例报道如下。     

皮肌炎并发横纹肌溶解致急性肾衰竭一例

皮肌炎(DM)是一类主要累及皮肤及横纹肌的自身免疫性疾病.横纹肌溶解综合征(RM)是各种原因致横纹肌损伤,释放大量肌红蛋白(Mvo)、肌酸磷酸激酶(CK)进入外周血的一组临床和实验室综合征,肌红蛋白损伤、阻塞肾小管可导致急性肾衰竭(ARF).DM并发RM导致ARF国内外罕见报道.现将我院收治1例报告如下.     

连续性静脉-静脉血液滤过对内毒素休克羊血液动力学和炎性介质的影响

目的观察连续性静脉.静脉血液滤过(CVVH)对内毒素休克血液动力学和炎性介质的影响。方法 雄性绵羊12只,随机分为两组。对照组(A组,n=6),内毒素以1 mg·kg-1静脉泵注,30min内完成,同时静脉输注林格液15 ml·kg-1·h-1,持续6 h;血滤组(B组,n=6),于开始泵注内毒素后1 h给予CVVH治疗5 h,其余处理同A组。所有动物均给予气管插管、镇静、肌松、控制呼吸,行有创血液动力学监测;两组分别于内毒素泵注前(T0)、开始泵注后30、60、90、120、210、360 min(T1～T6)采静脉血及超滤液4ml,测定血浆及超滤液中内毒素、TNF-α、IL-6、IL-10的浓度。结果 血滤组CVVH治疗后(T1-T6)平均动脉压及体循环阻力指数明显上升、心率显著性下降。TNF-α于泵注内毒素后(T1-T6)两组均显著性增高,血滤组于CVVH治疗60 min(T4)时较治疗前(T2)虽无明显改变,但明显低于同时点对照组(P<0.01),CVVH治疗150～300 min(T5-T6)时TNF-α浓度较对照组及治疗前(T2)均显著性降低(P<0.05);IL-10虽呈增高趋势,但较治疗前和对照组无显著性变化;而两组IL-6水平则无明显差异。超滤液中可检测到TNF-α、IL-6、IL-10。结论 血滤治疗有利于纠正促炎细胞因子过度释放和抗炎细胞因子失衡,改善内毒素休克血液动力学。     

连续性血液净化治疗感染性休克疗效分析

目的报告用连续性血液净化（CBP）治疗感染性休克,并探讨其疗效。方法在综合治疗的同时,辅以CBP治疗。所有患者留置中心静脉导管及动脉导管测中心静脉压和平均动脉压,检测动脉血乳酸。滤器为AV600,置换液配方为0．9％NaCl3000ml、5％葡萄糖170ml、注射用水820ml、10％caCl26．4ml、50％MgS041．6ml装入4L输液袋,制成4L／袋的成品（A液部分）。使用前根据患者血钾水平适量加入10％KCl与5％NaHC03250ml（B液部分）,由不同的通路按（4000mlA液：250mlB液）同步输入,以免发生沉淀。5％NaHC03在整个治疗过程中匀速补充,以纠正酸中毒。置换液流量为4L／h,首次连续治疗48～72h,以后根据病情再决定CBP。结果治疗前后患者的pH值、氧合指数、动脉血乳酸浓度、平均动脉压等指标明显改善;在多巴胺停用48h内血压正常者共6例,72h内共10例,合并多器官功能衰竭（MODS）8例,其中4例在感染休克后48h后作CBP治疗。共治愈19例,死亡7例,死亡7例中并发MODS5例。结论CBP治疗感染性休克是行之有效的方法;经CBP治疗,死亡率有明显降低,但应尽早进行。     

床旁血液灌流联合连续性静脉静脉血液滤过抢救苯巴比妥东莨菪碱中毒致呼吸停止一例

血液灌流(HP)和连续性静脉静脉血液滤过(CVVH)已成为抢救危重中毒患者的有效方法.我院使用床旁HP联合CVVH成功抢救苯巴比妥东莨菪碱中毒致呼吸停止1例.     

Continuous venovenous hemofiltration and hemoperfusion in successful treatment of a patient with crush syndrome and acute pancreatitis

In this article, we report a patient with crush syndrome (CS) who developed acute renal failure (ARF) and acute pancreatitis. Continuous venovenous hemofiltration (CVVH) and intermittent hemoperfusion (HP) were successfully performed in this patient and satisfactory effects were achieved. The treatment of this patient suggested that early intervention with continuous renal replacement therapy (CRRT) may be useful and a multiple-mode treatment may be a better choice.     

连续静脉静脉血液滤过成功救治9个器官功能障碍患者一例

患者，男性，44岁。2006年2月21日，被尖刀刺伤致左股动静脉断裂、膀胱穿孔、左精索断裂、回肠穿孔及后腹膜损伤。现场抢救后送到我市某医院时心跳、呼吸已停止。经复苏术恢复心跳后即紧急进行股动静脉人工血管置换术、回肠穿孔修补术、膀胱穿孔修补术及后腹膜破裂修补术。     

阿奇霉素治疗小儿肺炎支原体感染的临床疗效观察

目的：探讨阿奇霉素治疗小儿肺炎支原体感染的临床疗效,为其临床治疗提供可参考依据。方法共纳入82例入住我院诊断为肺炎支原体感染的患儿作为研究对象,采用随机数字法平均分为观察组与对照组,观察组患儿给予阿奇霉素治疗,对照组给予罗红霉素治疗,对两组患儿的住院时间、临床疗效等进行比较。结果观察组治疗总有效率明显优于对照组,总有效率分别为97.6％及85.3％,差异有统计学意义（P ＜0.05）;且观察组住院时间明显低于对照组,差异有统计学意义（P ＜0.05）。观察组出现恶心、呕吐的例数明显低于对照组,差异有统计学意义（P ＜0.05）。结论阿奇霉素治疗小儿肺炎支原体感染有较好的临床疗效,可以更好的改善患者的症状,同时安全性较高,值得临床推广应用。     

Continuous venovenous haemofiltration for the treatment of theophylline toxicity

In patients with severe theophylline toxicity charcoal haemoperfusion is the recommended method for rapid reduction of serum theophylline levels. However, access to this technique is limited in most hospitals. This case report shows that continuous venovenous haemofiltration, a technique available in most hospitals, is an effective alternative to charcoal haemoperfusion.     

Multidisciplinary treatment by pneumonectomy, PMX and CHDF in a case of pulmonary suppuration complicated with septic shock.

A 68-year-old male, who had suffered from pulmonary tuberculosis with cavities on the right upper lobe, developed breathlessness, bloody sputum, right chest pain and fever. His laboratory data on admission showed severe infection or sepsis (WBC 2,600/mL, CRP 40.2 mg/dL), and his respiratory condition rapidly worsened. In the intensive care unit (ICU) he was given continuous hemodiafiltration (CHDF), but his respiratory condition failed to improve and it was therefore decided to perform a right pneumonectomy. His severe hypoxemia was resolved but because high dose catecholamines medication was still required, polymyxin-B immobilized fiber (PMX) and CHDF were performed. The operation was successful and he was transferred from the ICU to a general ward seven days postoperatively. The vicious circle of septic shock presenting in this case was successfully broken by the pneumonectomy and subsequent treatment by PMX and CHDF, which eliminated the causative factors of sepsis. (Ann Thorac Cardiovasc Surg 2003; 9: 319-22)     

急性腹壁坏死性筋膜炎合并脓毒性休克的救治

目的探讨急性坏死性筋膜炎合并脓毒性休克的诊断和治疗,提高早期诊断和综合救治水平。方法报告3例急性腹壁坏死性筋膜炎合并脓毒性休克、多器官功能衰竭的早期诊断和早期病灶的切开引流、脓毒性休克的抢救和脏器功能支持、后期创面的修复和愈合,并复习国内外相关文献。结果 3例诊断后及时手术切开引流、积极抢救脓毒性休克稳定生命体征、后期切口拉拢缝合、创面愈合良好,患者痊愈。结论早期明确诊断、及时切开清创引流、延期修复创面并结合积极抢救休克和脏器功能支持的综合治疗是救治急性坏死性筋膜炎合并脓毒性休克的关键。     

Continuous veno-venous hemofiltration improves hemodynamics in septic shock with acute renal failure without modifying TNFalpha and IL6 plasma concentrations

BACKGROUND: Continuous hemofiltration improves hemodynamics in critically ill patients by removing cytokines from the plasma. The mechanism, however, remains to be clarified since recent studies show conflicting findings. The present study was therefore designed to evaluate hemodynamic changes and kinetics of tumor necrosis factor (TNF)alpha, interleukin (IL)1beta and IL6 in patients with septic shock and acute renal failure (ARF) undergoing continuous veno-venous hemofiltration (CWHF), over a 24-hour period. METHODS: Eleven patients admitted to the ICU for septic shock with ARF were investigated with radial artery and pulmonary artery catheterization during isovolemic CWHF using AN69 hemofilters at a blood flow rate of 240 mL/min and ultrafiltration 1.65 +/- 0.33 L/h. Hemodynamic measurements (mean arterial pressure, right arterial pressure, pulmonary artery pressure, pulmonary vascular resistance, systemic vascular resistance, cardiac output and tissue oxygenation indeces) were obtained before and after 2h, 4h, 6h, 12h and 24 h of CVVHF. Blood samples from the pre- and postfilter lines and ultrafiltrate samples were collected for the radioimmunoassay of TNFalpha, IL1beta and IL6 before and at 2h, 4h, 6h, 12h and 24h. RESULTS: During CVVHF, mean arterial pressure rose from 67 +/- 7 mm Hg to 89 +/- 5 mm Hg (p < 0.05) and indexed systemic vascular resistance from 711 +/- 153 dyne.s.cm(-5)/m2 to 1,200 +/- 100 dyne.s.cm(-5)/m2 (p < 0.05). Serum lactate and oxygen consumption did not change. Mean arterial pressure and systemic vascular resistance were not correlated to the lowering of body temperature during CVVHF. Significant clearance of IL6 was achieved, but not of TNFa, though the plasma concentrations of both cytokines were unaffected throughout the study. IL1beta was not detectable. Two patients were discharged alive with normal renal function. CONCLUSION: In patients with septic shock and ARF, CVVHF improves mean arterial pressure and systemic vascular resistance. This effect does not appear to be related to the removal of cytokines. The effect of CVVHF on mortality and morbidity in the long term, in septic shock has still to be established.     

感染性休克抗感染治疗的回顾性分析

目的回顾性分析急诊科感染性休克患者采用6 h集束化抗感染治疗的实施及临床疗效。 方法回顾性分析本院急诊科2013年1月至2014年12月集束化抗感染治疗的感染性休克患者173例的临床资料,观察分析患者的一般资料,病死率及其相关因素、集束化治疗方法,完全集束化治疗实施率及完全集束化治疗对病死率的影响。 结果年龄高于60岁、APACHE Ⅱ评分高于20分、全身炎症反应综合征（SIRS）及多脏器功能失常综合征（MODS）发生为感染性休克患者病死的独立高危因素。血乳酸检测实施率（93.6%）、3 h内广谱抗菌药物应用实施率（95.4%）、液体复苏效果不佳给予升压治疗实施率（91.3%）较高,但完全集束化抗感染治疗仍有较大的上升空间,其中抗菌药物治疗前病原菌培养实施率较低（69.9%）,完全集束化治疗者病死率（36.7%）低于非完全集束化治疗病死率（56.7%）（χ² = 6.564、P = 0.0104）。 结论感染性休克患者急诊6 h内完全集束化抗感染治疗能够有效的达成目标化治疗指标控制,提升急诊医师对完全集束化治疗的实施率能够进一步降低感染性休克患者的病死率。