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高容量连续性静脉-静脉血液滤过治疗多脏器功能障碍综合征(13例临床分析)

HIGH VOLUME CONTINUOUS VENO VENOUS HEMOFILTRATION IN MULTIPLE ORGAN DYSFUNCTION SYNDROME-AN ANALYSIS OF 13 CASES

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【作者】 丁峰顾勇陆福明樊淑玲薛俊李铭新杨海春徐雅萍林善锬

【Author】 Ding Feng,Gu Yong,Lu Fuming,Fan Shuding,Xue Jun,Li Mingxin,Yang Haichun,Xu Yaping,Lin Shanyan Department of Nephrology,Huashan Hospital,Shanghai Medical University,Shanghai,200040

【机构】 上海医科大学华山医院肾脏病科

【摘要】 目的:探讨高容量连续性静脉-静脉血液滤过治疗多脏器功能障碍综合征的效果。方法:13例多脏器功能障碍综合征患者接受3.0~4.0L/h置换液输入速度的连续性静脉-静脉血液滤过技术,平均治疗时间为62.3h。结果:13例患者死亡6例,存活7例;9例治疗前需用升压药维持血压的患者治疗后30min平均动脉压有显著上升,心率则有显著下降;治疗后12h血清Na+、Cl-、Ca2+和动脉血气中的pH、HCO-3、PO2、PCO2均无显著变化,而血清BUN、Cr、K+则有显著下降;血浆IL-1β、TNF-α水平在治疗后12h也有显著下降;治疗后30minIL-1β、TNF-α的筛系数显著低于治疗后12h的筛系数。结论:高容量连续性静脉-静脉血液滤过能清除大量的细胞因子,改善血流动力学,可用于多脏器功能障碍综合征的治疗

【Abstract】 OBJECTIVE To study the effect of high volume continuous veno venous hemofiltration in multiple organ dysfunction syndrome. METHODOLOGY 13 patients with multiple organ dysfunction syndrome underwent high volume continuous veno venous hemofiltration of a mean duration of 62 3 hours.The infusion rate of replacement fluid was about 3 0~4 0 L/hr. RESULTS 6 patients died during the course of treatment.There was a significant increase in mean arterial pressure and a drop in heart rate after 1/2 hour treatment in 9 cases who required vasoactive drugs to maintain blood pressure.No change was found in serum Na +,Cl -,Ca 2+ and in blood pH,HCO 3- ,PO 2,Pco 2 after 12 hours therapy,while a significant decrease in serum BUN,Cr,K + and plasma IL 1β,TNF α was found.The sieve coefficients of IL 1β,TNF α after 1/2 hour treatment were greater than those after 12 hours treatment. CONCLUSION High volume continuous veno venous hemofiltration,with which enhanced clearance of cytokines and improved hemodynamics can be achieved,is an effective treatment for multiple organ dysfunction syndrome.

  • 【文献出处】 肾脏病与透析肾移植杂志 ,CHINESE JOURNAL OF NEPHROLOGY, DIALYSIS & TRANSPLANTATION , 编辑部邮箱 ,1998年06期
  • 【分类号】R459.5
  • 【被引频次】32
  • 【下载频次】54
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