连续性血液净化治疗在重症监护病房的临床应用

目的 研究连续性血液净化治疗的各种方式对多器官功能障碍综合征患者炎症因子的清除作用及对预后的影响.方法 对112例多器官功能障碍综合征患者根据病因分为3组,分别进行连续静脉-静脉血液滤过/连续静-静脉血液透析、血液灌洗+连续静脉-静脉血液滤过/连续静-静脉血液透析、持续高容量血液滤过治疗,观察生命体征变化,检测生化指标,计算急性生理学及慢性健康状况评分Ⅱ等,并分别于治疗开始时(0 h)和治疗后3、24 h取血检测肿瘤坏死因子α、白细胞介素6、C反应蛋白.结果 治疗前、后3组间在生命体征变化、生化指标检测比较差异无统计学意义(P＞0.05).治疗24 h后,连续静脉-静脉血液滤过/连续静-静脉血液透析和血液灌洗+连续静脉-静脉血液滤过/连续静-静脉血液透析组的肿瘤坏死因子α、白细胞介素6、C反应蛋白浓度比较无差异无统计学意义(P＞0.05);而持续高容量血液滤过组的患者炎症因子在治疗后3 h及治疗结束分别呈不同程度的下降.3组间APACHE Ⅱ评分比较差异无统计学意义(P＞0.05),治疗转归和病死率比较差异无统计学意义(P＞0.05).结论 在清除炎症因子方面,持续高容量血液滤过模式明显优于连续静脉-静脉血液滤过/连续静-静脉血液透析和血液灌洗+连续静脉-静脉血液滤过/连续静-静脉血液透析.

Abstract：

Objective To research the clear role of inflammatory factors and the affect of prognosis about the various treatment of CBP for the patients who got Multiple Organ Dysfunction Syndrome. Method 112 patients who got Multiple Organ Dysfunction Syndrome were conducted separately the CVVH/CWHD or HP+ CVVH/CVVHD or HVHF treatment according to the cause of disease, observing the change of vital sign, detecting the biochemical indicators, calculating APACHE Ⅱ and so on, and detecting the TNF-α,IL-6, CRP from the blood when the begin, after 3 hour s and after 24 hours of the treatment. Results Before and after the treatment, the changing of vital sign and biochemical indicators have no significant incentives (differences) in the 3 groups. After 24 hours of the treatment, the concentrations of TNF-α, IL-6 and CRP have no significant changes between the groups of CVVH/CVVHD and HP+ CVVH/CVVHD. However the patients' inflammatory factors of HVHF group have different falling after 3 hours and the end of the treatment. In the 3 groups, APACHE Ⅱ has no differences, prognosis and Mortality have no significant differences. Conclusion In the clearing inflammatory factors, the model of HVHF is better than the models of CVVH/CVVHD and HP+ CVVH/CVVHD.

Clinical analysis of Continuous blood purification for ICU

Objective To research the clear role of inflammatory factors and the affect of prognosis about the various treatment of CBP for the patients who got Multiple Organ Dysfunction Syndrome. Method 112 patients who got Multiple Organ Dysfunction Syndrome were conducted separately the CVVH/CWHD or HP+ CVVH/CVVHD or HVHF treatment according to the cause of disease, observing the change of vital sign, detecting the biochemical indicators, calculating APACHE Ⅱ and so on, and detecting the TNF-α,IL-6, CRP from the blood when the begin, after 3 hour s and after 24 hours of the treatment. Results Before and after the treatment, the changing of vital sign and biochemical indicators have no significant incentives (differences) in the 3 groups. After 24 hours of the treatment, the concentrations of TNF-α, IL-6 and CRP have no significant changes between the groups of CVVH/CVVHD and HP+ CVVH/CVVHD. However the patients' inflammatory factors of HVHF group have different falling after 3 hours and the end of the treatment. In the 3 groups, APACHE Ⅱ has no differences, prognosis and Mortality have no significant differences. Conclusion In the clearing inflammatory factors, the model of HVHF is better than the models of CVVH/CVVHD and HP+ CVVH/CVVHD.