血浆置换联合连续性静脉-静脉血液滤过治疗多器官功能障碍综合征的临床观察

目的研究血浆置换（plasma exchange,PE）联合连续性静脉-静脉血液滤过（continuous venous-venous hemofiltration,CVVH）治疗多器官功能障碍综合征（MODS）患者的疗效。方法30例多器官功能障碍综合征患者除经内科常规治疗外,行PE联合连续性静脉-静脉血液滤过（CVVH）治疗,在治疗前、PE后、CVVH结束时,分别检测生命体征、血尿素氮、肌酐、动脉血氧分压及氧合指数、电解质、酸碱平衡的变化、C反应蛋白（C-reactive protein,CRP）及血肿瘤坏死因子a（tumornecrosis factor-alpha,TNF-a）,并进行ICU监护的结果记录。以APACHEⅡ评分及SIRS评分判断患者病情的变化。在治疗过程中,血流动力学稳定,血浆置换后血CRP、血TNF-a明显下降（P〈0.05）,CVVH治疗前与治疗后相比、血尿素氮、肌酐、动脉血氧分压及氧合指数、电解质、酸碱平衡的变化APACHEⅡ评分及SIRS评分差异显著（P〈0.05）。结论PE联合CVVH治疗可显著改善多器官功能障碍综合征患者的临床症状,有效改善多器官功能障碍综合征的预后。

Clinical Objection on multiple organ dysfunction syndrome Treated with Plasma Exchange and continuous venousvenous hemofiltration

Objective To investigate the effect of plasma exchange（PE） and continuous venous-venous hemofiltration（CVVH） in the treatment of multiple organ dysfunction syndrome（MODS）.Methods 30 patients with MODS were treated with PE and CVVH except general management,the index of the vital sign,blood urea nitrogen,creatinine,arterial partial pressure of oxygen,oxygenation,electrolytes and acid-base balance of the patients C-reactive protein（CRP） were determined before and after treatment.Results All the patient tolerated the treatment of PE and CVVH.The data showed that C-reactive protein（CRP） were decreased significant differences following PE（P〈0.05）,so did the index of the vital sign,blood urea nitrogen,creatinine,arterial partial pressure of oxygen,oxygenation,electrolytes and acid-base balance of the patients the APACHE II.SIRS after CVVH（P〈0.05）.Conclusion The data indicated that PE and CVVH was an effective method for improving MODS.It might be of clinical benefit to the prognosis of patient with MODS.