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。

The application of continuous veno-venous blood hemofiltrition in the multiple organ dysfunction syndrome in the elderly

Objective To investigate the efficacy of the continuous veno-venous blood hernofiltrition （CVVH） in the treatment of elderly multiple organ dysfunction and to explore values of CVVH application in such patients. Method A retrospective analysis was performed from May 2005 to November 2007 on 32 cases of MOD treated by CVVH. The changes in blood pressure, blood gas analysis and removal of toxins, dielectric fluctuations and the APACHE Ⅱ score during the treatment were observed. Result 16 cases survived over 2 weeks, APACHE Ⅱ score was （20. 7 ± 4. 30） at beginning, and 12 cases got clinical recovery finally. APACHE Ⅱ score in death group was statistically significantly higher than in survived group （27. 0 ± 4. 37 vs 13. 8 ± 3. 86, P〈0. 01）. In the survival group, blood pressure was reduced and indicators for blood gas analysis improved gradually during the treament. There were statistical significances （P〈0. 05） before and after treatment. In 8 cases of shock whose blood pressure was maintained by pressor agents before the treatment, the doses of agents were reduced gradually and the drugs withdrawn finally after CVVH. In the patients complicated with heart failure got stable heart function during the treatment of CVVH. Of 17 cases associated with acute renal failure, MODS was induced by pulmonary infection in 13 cases, During the 13 cases, the internal environment stable, and urine volume increased to varying degrees after the treatment. Finally, 8 patient died because of resistant pathogens, and one case suffered from chronic renal insufficiency. No serious complications related to blood purification treatment occurred during the treatment. Conclusion CVVH is an effective aid in old patient with multiple organ dysfunction and can improve the prognosis of them.