连续性血液净化治疗多脏器功能衰竭九例临床观察

目的 探讨连续性血液净化对多脏器功能衰竭的抢救与治疗.方法 在常规治疗基础上给予连续性血液净化治疗.结果 治疗前、后血肌酐、谷丙转氨酶、肌酸磷酸激酶比较差异有学意义(P均<0.05).结论 连续性血液净化治疗对多脏器功能衰竭的抢救有重要作用.     

连续性血液净化治疗在多脏器功能障碍综合征患者中的应用

目的：探讨连续性血液净化(CBP)治疗在多脏器功能障碍综合征(MODS)惠中的疗效。方法：9例伴急性肾衰竭(ARF)的MOD6患，共进行43例次的连续性血液净化治疗，以连续性静脉一静脉血液滤过(CVVH)和连续性静脉—静脉血液透析(CVVHD)为主，根据病情需要加做血浆置换(PE)或血液灌流(HP)。连续性血液净化治疗期间随时监测血压、心率、中心静脉压等生命体征，根据需要检测肾功能、电解质、动脉血气、肝功能等。结果：9例患在连续性血液净化治疗期间，生命体征稳定，血尿素氮、肌酐、血钾等的清除较满意，脱水量均可迭预期目标。连续性血液净化治疗未发生严重副作用。9例患经治疗后2例治愈，1例好转出院，自动出院2例，死亡4例。结论：连续性血液净化是较好的治疗多脏器功能障碍综合征的血液净化方法，在多脏器功能障碍综合征患的抢救中取得了一定的疗效。     

连续性血液净化治疗多脏器功能障碍综合征

多脏器功能障碍综合征(MODS)是严重创伤、严重感染、外科大手术、病理产科等原发病发生后,同时或序贯出现两个或两个以上系统器官的功能不全或衰竭的临床综合征,病死率较高.我院近年来采用连续性血液净化(CBP)抢救此类患者11例,现报告如下.     

血液净化技术在热射病伴急性肾功能衰竭救治中的应用

热射病即重度中暑,可造成多脏器功能衰竭,病死率极高,近年来由于血液净化技术应用于热射病的抢救,取得可喜疗效.     

连续性肾脏替代治疗多脏器功能衰竭的疗效

目的 分析连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)对多脏器功能衰竭患者的疗效.方法 回顾性分析30例多脏器功能衰竭患者的临床资料,探讨CRRT治疗多脏器功能衰竭的疗效.结果 30例多脏器功能衰竭患者中15例痊愈,5例存活,10例死亡.结论 多脏器功能衰竭是临床上的急危重症,发病凶险,死亡率高,CRRT对多脏器功能衰竭患者有很好的疗效.     

连续性血液净化在热射病并发高热及多脏器功能障碍综合征中的应用

目的 探讨连续性血液净化救治热射病并发高热及多脏器功能障碍综合征的临床效果.方法 应用AsahiKSEI ACH-10CRRT机持续静脉-静脉血液滤过模式辅助治疗热射病高热并多器官功能障碍.10例患者均为物理降温及药物治疗效果差,在多器官功能障碍状态下接受连续性血液净化治疗共计727 h.结果 (1)连续性血液净化治疗中患者平均动脉压、中心静脉压、急性生理学及慢性健康状况评分指标与治疗前比较差异有统计学意义(P＜0.05);血肌酐、肌酸激酶水平与治疗前比较差异也有统计学意义(P＜0.05);(2)全部患者均治愈出院,无后遗症,平均连续性血液净化治疗时间为(56±29)h;(3)对5例严重昏迷、并发急性呼吸窘迫综合征、弥散性血管内凝血患者连续实施连续性血液净化治疗平均69h,当其意识恢复、气管插管拔除后停止连续性血液净化治疗.结论 采用连续性血液净化技术辅助治疗热射病高热及多器官功能障碍可有效缓解症状,为进一步使用药物及其他治疗争取时间,是一种有效地辅助治疗手段.     

连续性血液净化的护理体会

多脏器功能障碍综合征(MODS)是严重创伤、严重感染、外科大手术、病理产科等原发病发生后,同时或序贯出现两个或两个以上系统器官的功能不全或衰竭的临床综合征.继往报道其死亡率高达62.5%～85.0%[1].为了提高MODS的抢救成功率,本院自2002年1月～2004年8月对31例MODS患者应用连续性血液净化治疗(CBP),取得了较满意的疗效,现将护理体会报道如下.     

原位肝移植术后重度肾功能不全处理成功三例

原位肝移植术后肾功能不全发生率高,处理不当会直接影响手术成功率.我院从2002年4月到2005年1月所做肝移植349例,术后出现重度肾功能不全达到需行血液净化治疗的有6例,除3例死于多脏器功能衰竭外,其余3例抢救成功,现报道如下.     

不同血液净化模式治疗重症急性胰腺炎的临床观察

重症急性胰腺炎（ severe acute pancreatitis,SAP）是临床上常见的危重症,因常伴有全身炎症反应和多脏器功能衰竭,故死亡率高。随着细胞因子、炎症介质、微循环障碍等学说的出现,对于SAP 的治疗目前更重视早期连续性血液净化治疗（ continuous blood purification,CBP）。现将我院对26例SAP患者进行血液灌流联合低容量血液滤过及高容量血液滤过治疗情况报道如下。     

使用伟力人工肝支持系统进行连续性肾脏替代治疗的护理体会

连续性肾脏替代治疗(CRRT)是目前抢救多脏器功能衰竭的有效手段.2003年6月～2004年3月我院使用北京伟力公司生产的人工肝支持系统对11例危重病人进行CRRT治疗取得了满意效果. 　　……     

连续性静脉-静脉血液滤过在老年多器官功能障碍中的应用

目的观察连续性静脉-静脉血液滤过（continuous venc-venous blood hemofihrition，CVVH）治疗老年多器官功能障碍的疗效，探讨其应用价值。方法回顾性分析2005年5月至2007年11月期间在我院住院发生多器官功能障碍并接受CVVH治疗的危重患者32例。观察治疗过程中血压、血气分析、毒素清除、电解质的波动及APACHEⅡ评分的变化情况。结果治疗开始时APACHEⅡ评分为（20．7±4．30），存活时间超过2周者16例，临床痊愈12例。死亡组患者APACHEⅡ评分为（27．0±4．37），存活组评分为（13．8±3．86）。存活的患者，治疗过程中血压、血气分析等指标逐渐好转，治疗前后比较差异具有统计学意义。8例治疗前休克需要升压药维持血压者，治疗后5例升压药物逐渐减量、停药；合并心衰者治疗过程中心功能稳定；合并急性肾衰竭者17例，其中13例为肺部感染诱发多器官功能障碍综合征（MODS），治疗过程中内环境稳定，治疗后尿量均有不同程度好转，最终因病原菌耐药8例死亡、1例肾功能未恢复转变为慢性肾功能不全；治疗过程中未发生血液净化治疗相关的严重并发症。结论连续性静脉-静脉血液滤过是老年多器官障碍治疗中有效的辅助手段，可明显改善患者预后。     

连续性血液净化治疗急性有机磷农药中毒的疗效观察

目的分析研究连续性血液净化对急性有机磷农药中毒患者的治疗效果及安全性。方法选择2008年1月～2013年9月我院急性有机磷农药中毒患者共70例为临床研究对象,将患者分为两组。对照组患者给予临床常规治疗,实验组患者给予HP＋CVVH序贯治疗,观察比较两组患者的治疗过程中发生低氧血症、呼吸衰竭、脏器损伤及死亡率和患者血清SOD等指标。结果实验组患者发生低氧血症、呼吸衰竭、脏器损伤低于对照组患者,死亡率低于对照组患者,差异有统计学意义（P〈0．05）。实验组患者治疗后血清hs—CRP水平更低,胆碱酯酶活性优于对照组患者,差异有统计学意义（P〈0．05）。结论使用连续性血液净化对急性有机磷农药中毒具有较好的效果,可以有效地降低患者的死亡率,减轻患者的损伤。     

连续性血液净化在乳酸性酸中毒治疗中的应用

目的 观察连续性血液净化在乳酸性酸中毒治疗中的应用效果。方法 选择11例确诊为乳酸性酸中毒患者,在常规治疗效果不显著时予连续性血液滤过,治疗过程中行血气分析,检测血乳酸、血糖、血肌酐水平。结果 治疗后血pH、HCO3^-接近正常,乳酸、肌酐显著下降（P〈0．01）。结论 连续性血液净化在乳酸性酸中毒的治疗中发挥重要的作用,特别是对内科保守治疗效果差或合并肾功能不全的患者。     

Hemoperfusion plus continuous veno-venous hemofiltration in a pregnant woman with severe acute pancreatitis: a case report

Severe acute pancreatitis is a common critical disease, which may cause severe complications such as sepsis and multiple organ dysfunction syndrome (MODS), and has a high mortality. A 31-year-old woman with 25-weeks pregnancy presented with hyperlipidemic pancreatitis, sepsis and MODS. Based on conventional treatment, 125?h of continuous veno-venous hemofiltration (CVVH) and 3 sessions of hemoperfusion (HP) were carried out. The treatment turned out to be very successful. We suggest that early intervention by blood purification therapy, and CVVH combined with HP could be effective in severe acute pancreatitis.     

Continuous transcatheter arterial thrombolysis for early hepatic artery thrombosis after liver transplantation

Early hepatic artery thrombosis (HAT) after orthotopic liver transplantation remains a significant cause of graft loss and patient death. The most effective treatment approach is still controversial. The purpose of this study was to assess the effect of continuous transcatheter arterial thrombolysis in the treatment of early HAT. Routine posttransplant color Doppler imaging (CDI) was performed to monitor hepatic artery blood flow. HAT was confirmed by arterial angiography in suspected cases. HAT was identified in 8 patients (8/287, 2.8%) which occurred on days 2 to 19 (mean, 5.2 days) after liver transplantation. Patients with HAT were treated with continuous transcatheter arterial thrombolysis using urokinase. Successful revascularization through thrombolysis was obtained in all eight cases. One patient died of a pulmonary infection at 2 months after liver transplantation. Another patient underwent retransplantation because of resistant allograft rejection and recurrence of HAT 6 months after the first operation, but died from multiple system organ failure 2 months later. The other six patients remained in good health during the follow-up period of 3 to 27 months. Our results demonstrate that CDI is an effective method to monitor the occurrence of early HAT after liver transplantation. Furthermore, continuous transcatheter arterial thrombolysis with urokinase could be a rational therapeutic approach to rescue the allograft following early HAT diagnosis confirmed by arterial angiography.     

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。2005年5月-2009年8月．“将持续血液净化应用于热射病合并MODs患者11例（男10例,女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侧痊愈。出院,2例焉亡;cBP治疗中患者血流动力学保持相对稳定．平均动脉压．心率和氧台指数均有所改善,,多巴胺剂照逐渐减少（p〈0．05）．APACHE11评分降低（P〈0．05）;血中肌酐,尿素氮．肌红蛋白0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：持续血液净化对热射病台并MODS患者有改善预后的作用．患者耐受性好,是抢救热射病合并MODS患者有效手段之一。     

Cytokine removal in septic patients with continuous venovenous hemofiltration

Despite the progress that has been made in intensive care medicine, multiple organ failure is still associated with high mortality. Apart from the prevention of infectious complications, numerous efforts are being made to improve the treatment of sepsis through adequate antibiotic therapy, the development of new respirator therapies, better control of the hemodynamic situation, and adequate renal replacement therapy. Some authors advocate continuous renal replacement therapy not only for acute renal failure but also for the elimination of inflammatory molecules such as cytokines. Continuous renal replacement therapy improves the cardiovascular hemodynamics in patients with multiple organ failure. Therapeutic options such as volume control, clearance of uremic toxins, correction of acid base disturbances and temperature control are improved. Suitable renal replacement therapy improves not only cardiovascular hemodynamics but also patient survival. In current practice, continuous renal replacement therapy is not used to eliminate mediators such as cytokines. In patients with multiple organ failure and compromised cardiovascular hemodynamics, renal replacement therapy should be carried out as early as possible. In the following review, experimental and clinical findings concerning mediator elimination by continuous and intermittent renal replacement therapy are summarized.     

Early goal-directed therapy (EDGT) using continuous central venous oxygen saturation monitoring in a patient with septic shock

Septic shock is an adverse clinical condition resulting in multiple organ failure from global tissue hypoxia. The importance of initial treatment is widely recognized. Thus, guidelines for septic shock recommend early goal-directed therapy (EGDT) during the first six hours of treatment. Central venous oxygen saturation monitoring is useful to maintain adequate tissue oxygen delivery. A newly developed central venous oximetry catheter (PreSep Oximetery Catheter, Edwards Lifesciences) allows continuous and easy monitoring of central venous oxygen saturation. This report shows the usefulness of this catheter in a patient who developed septic shock during an emergency operation for perforated bowel. By using EGDT perioperatively with continuous central venous oximetry, multiple organ failure might be successfully avoided.