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目的探讨配对血浆滤过吸附(CPFA)治疗重症感染并多器官功能障碍综合征(MODS)的临床疗效。方法MODS患者7例,均在常规药物治疗基础上加用CPFA和高容量血滤(HVHF)治疗各10 h,治疗顺序随机,间隔一夜洗脱期(12 h),比较两种血液净化方式的临床效果及对C反应蛋白(CRP)的影响。结果(1)两种治疗平均动脉压(MAP)均明显升高,且升压药应用量减少。APACHEⅡ评分:CPFA治疗前25.25±7.18,治疗后降至19.00±6.83(P<0.05)。(2)与HVHF相比,CPFA同样能很好地维持机体电解质、酸碱的平衡状态,明显降低血尿素氮、肌酐水平,改善血氧分压和氧合指数。(3)CPFA治疗后CRP由(124.92±43.88)mg/L降至(94.66±35.43)mg/L(P<0.05),降势明显大于HVHF后(P<0.05)。(4)CPFA治疗过程中无一例发生凝血、出血、过敏、栓塞等不良反应。(5)患者的平均预期病死率是54%,实际5例存活,1例死亡,1例自动出院。结论CPFA治疗MODS有效、安全,在降低CRP方面优于HVHF。
Objective To investigate the clinical efficacy of paired plasma filtration adsorption (CPFA) in the treatment of severe infections and multiple organ dysfunction syndrome (MODS). Methods Seventeen patients with MODS were treated with CPFA and high-volume hemofiltration (HVHF) for 10 hours on the basis of routine drug therapy. The treatment sequence was randomized and separated by one night interval (12 h). Two methods of blood purification Clinical effects and effects on C-reactive protein (CRP). Results (1) The mean arterial pressure (MAP) of both treatments were significantly increased, and the amount of vasopressors decreased. APACHE II score: 25.25 ± 7.18 before CPFA treatment and 19.00 ± 6.83 after treatment (P <0.05). (2) Compared with HVHF, CPFA can also maintain body electrolyte, acid-base balance, reduce blood urea nitrogen and creatinine, and improve oxygen partial pressure and oxygenation index. (3) After CPFA treatment, CRP decreased from (124.92 ± 43.88) mg / L to (94.66 ± 35.43) mg / L, P <0.05). (4) No cases of coagulation, hemorrhage, allergy, embolism and other adverse reactions occurred during CPFA treatment. (5) The average expected mortality of patients was 54%. In fact, 5 patients survived, 1 died and 1 patient was discharged automatically. Conclusions CPFA is effective and safe in the treatment of MODS and superior to HVHF in reducing CRP.