【摘要】 目的 :探讨连续性高容量血液滤过 (continuous high volum e hem ofiltration,CHVHF )在多脏器功能障碍综合征(multiple organ dysfunction syndrome,MODS)救治中的应用效果。方法 :应用 CHVHF治疗 MODS患者 5 8例 ,采用 FreseniusADM0 8TM/ ABMTM型肾替代治疗床边机 ,血滤器采用 Fresenius聚砜膜 AV6 0 0 S,置换液为 Fresenius4 0 0 8B- on line透析机制备碳酸氢盐置换液 ,置换液输入量 4 0 0 0～ 6 0 0 0 ml/ h,前稀释输入 ,39例 <6 0 L/ 2 4 h,19例 6 0～ 14 4 L/ 2 4 h,血流量 2 5 0～ 30 0ml/ min,每天治疗 8～ 2 4 h,平均 CHVHF(38± 10 .4 ) h。结果 :31例 (5 3.4 % )存活 ,2 7例 (46 .6 % )死亡 ,停止 CHVHF时平均BU N、Scr、CVP均显著降低 (P <0 .0 1) ,平均 Pa O2 、MAP均显著升高 (P <0 .0 1) ,而多巴胺用量显著降低 (P <0 .0 1) ;置换液输入量 6 0～ 14 4 L/ 2 4 h患者存活率显著高于 <6 0 L/ 2 4 h患者 (P <0 .0 5 )。结论 :CHVHF显著改善 MODS患者血流动力学 ,有助于提高生存率 ;CHVHF治疗剂量越大 ,预后越好。更多还原

【Abstract】 Objective:To evaluate the effect of continuous high volume hemofiltration (CHVHF) in the patiens with multiple organ dysfunction syndrome (MODS).Methods:Fifty-eight MODS patients were treated with CHVHF by using Fresenius ADM08 TM/ABM TM machine and Fresenius AV600 Polysulfone membrane hemofilter, the bicarbonate substitution was made by Fresenius on-line hemofiltration equipment and infused by pre-dilutinal with the flow of 4 000～6 000 ml/h,the dosage of treatment:Thirty-nine patients were under 60 L/24 h,and nineteen patients were from 60 L/24 h to 144 L/24 h.In the treatment,the blood flow rate was 250～300 ml/min,and all the patients were treated for 8 to 24 hours one day,the average time of every patient of CHVHF was (38±10.4) hours.Result:Thirty-one(53.4%)of the patients survived,and twenty-seven(46.6%)patients died. After treatment the average of BUN, Scr, CVP were significantly decreased(P<0.01), but PaO 2,MAP were significantly increased(P<0.01), and dose of Dopamine reduced significantly(P<0.01). The survival rate of the patients with substitution fluid from 60 L/24 h to 144 L/24 h was higher than those under 60 L/24 h (P<0.05).Conclusion:CHVHF was effective in alleviating hemodynamics of patients with MODS, and can increase the survival rate. The higher dosage of treatmemt in the CHVHF,the better prognosis.更多还原