多脏器功能障碍综合征患者连续性血液净化的效果

目的 探讨连续性血液净化（CBP）用于多脏器功能障碍综合征（MODS）患者的效果。方法 MODS患者20例，男性13例，女性7例，年龄40—87岁，ASA分级Ⅱ级7例、Ⅲ级13例，均符合MODS和急性呼吸窘迫综合征的诊断标准。经右侧股静脉置管，使用持续性肾脏替代治疗机以高容量连续性静脉．静脉血液滤过（HV—CVVH）模式治疗。于第1次CBP前、CBP开始后2、4、6h及CBP停止后6h测定心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、pH、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、氧合指数（PaO2／FiO2）、肺动态顺应性（Cdyn）、气道阻力（Raw），同时抽取静脉血2ml测定血液BUN、Scr、Glu、Na^＋、K^＋、Cl^-的浓度。结果 与第1次CBP前比较，pH、PaCO2、Na^＋、Cl^-、G1u差异无统计学意义（P〉0．05）；PaO2、PaO2／FiO2和Cdyn在CBP开始后2、4、6h时明显升高（P〈0．05）；Raw、BUN、Scr和K^＋明显降低（P〈0．05）；HR于CBP开始后2、4、6h以及CBP停止后6h时降低（P〈0．05）。结论 CBP能促进MODS患者的氧合功能，改善血液生化指标，维持内环境稳定，对血液动力学无明显影响。

Effect of continuous blood purification in the treatment of patients with multiple organ dysfunction syndrome

Objective To investigate the effect of continuous blood purification (CBP) in the treatment of patients with multiple organ dysfunction syndrome (MODS).Methods Twenty patients with MODS (13 males, 7 females) aged 40-87 yrs received CBP. All patients met the criteria of MODS and acute respiratory distress syndrome (ARDS) set by Chinese Society of Critical Care Medicine in 1995. A double-lumen catheter was placed in right femoral vein. High volume continuous venovenous hemofiltration (HV-CVVH) was performed 6 h/day using continuous renal replacement therapy device (Diapact CRRT, Braun, Germany) . MAP, HR, CVP, PaO2 , PaCO2 , PaO2/FiO2, dynamic lung compliance (Cdyn) airway resistance (Raw) and blood concentrations of BUN, creatinine, glucose, Na+,K+ and Cl- were measured and recorded before (baseline) and at 2, 4 and 6 h of and 6 h after the first CBP. Results There was no significant change in MAP, CVP, pH, PaCO2 and blood Na+, Cl- and glucose concentrations during and after CBP as compared with the baseline values before CBP. HR was significantly decreased after the 1st 6 h CBP. PaO2, PaO2/FiO2 and Cdyn were significantly increased while Raw was significantly decreased after CBP. Blood BUN creatinine and serum K+ concentration were significantly decreased after CBP.Conclusion CBP can improve respiratory function and decrease blood BUN, creatinine and serum K+ without significant effect on hemodynamics in patients with MODS.