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目的 观察连续性高流量血液滤过(HVHF)治疗严重感染伴有多器官功能障碍综合征(MODS)的临床疗效及安全性.方法 2005-2007年中国医科大学附属第一医院收治的20例确诊为产重感染伴有MODS的病人,平均APPACHEⅡ评分为23.8±8.3,平均SOFA评分为10.6±4.0,在常规治疗的基础上应用HVHF治疗至少3d,血流速度250mL/min,超滤量4L/h,置换液以前稀释方式输入,普通肝素抗凝,每24h更换滤器1次.比较治疗前后病人生命体征、血清尿素氮、肌酐、胆红素、动脉血乳酸、血小板、氧合指数及APPACHEⅡ评分和SOFA评分的变化,并监测治疗过程中的并发症.结果 20例病人在HVHF治疗后生命体征迅速稳定,体温、心率、呼吸频率降低,平均动脉压上升,血清尿素氮、肌酐水平下降,动脉血乳酸降低,血小板计数升高,氧合指数改善,APPACHEⅡ评分及SOFA评分降低,与治疗前相比差异具有统计学意义(P＜0.05),血清胆红素水平在治疗后来见明显改善.治疗过程中病人未见严重的离子及酸碱紊乱及其他并发症的发生.结论 连续性HVHF治疗能够降低严重感染伴有MODs病人的全身炎性反应,改善器官功能水平,未见严重并发症的发生,安全有效.

Clinical effects and safety of continuous high-volume hemofiltration on severe sepsis patients with multiple organ dysfunction syndrome

??Objective:To observe the clinical effects and safety of continuous high??volume hemofiltration (HVHF) on severe sepsis with multiple organ dysfunction syndrome (MODS). Methods:From 2005 to 2007,20 severe sepsis patients with MODS whose average APPACHE?? score was 23.8±8.3 and SOFA score was 10.6±4.0 underwent continuous HVHF therapy besides the common treatments.The blood flow rate was 250 mL/min and ultrafiltration rate was 4L/h,and the substitute fluid was infused with predilution.The unfractionated heparin was used for anticoagulation.The hemofilter was changed per 24h.The vital signs,blood urea nitrogen,creatitine,platelet,bilirubin,arterial lactic acid,oxygenation index,APPACHE?? and SOFA score of the patients were measured and compared before and after HVHF therapy.During HVHF therapy,the complications were monitored. Results:The vital signs of the patients became stable shortly after HVHF therapy with a decrease in temperature,respiratory rate and heart rate while an increase in mean arterial pressure.The level of blood urea nitrogen,creatitine,arterial lactic acid decreased,the count of platelet increased and the oxygenation index improved after HVHF therapy compared with those before treatment (P<0.05).The same thing occurred in APPACHE?? score and SOFA score.But the serum bilirubin level did not changed during HVHF therapy. Conclusion:HVHF therapy could decrease the systemic inflammation reaction of severe sepsis patients with MODS and improve organ function without any severe complications.