论文部分内容阅读
目的观察连续性静脉-静脉血液滤过(CVVH)治疗多器官功能衰竭(MODS)患者中APACHEⅡ积分、C反应蛋白水平、临床疗效及治疗中并发症的情况。方法选择2003年1月至2007年12月在本中心接受CVVH治疗的34例MODS患者,年龄19～91岁,平均(64±19)岁,APACHEⅡ积分为24.6±3.4,观察CVVH疗效及治疗过程中患者血压、心率、体温、呼吸等生命体征变化,监测其肝、肾功能,同时观察CVVH治疗中并发症情况。结果34例患者中存活时间超过14 d的有25例(73.6%),最终存活10例(29.4%),全部患者均存在肾功能衰竭,经CVVH治疗后明显好转。存活组年龄[(61±20)岁]明显低于死亡组[(72±16)岁],P<0.05,同时呼吸衰竭、凝血功能紊乱及心功能衰竭的发生率均明显低于死亡组。所有患者对CVVH治疗均耐受良好,治疗过程中血压、心率平稳,血流动力学稳定,存活组患者APACHEⅡ积分在治疗过程中明显下降,8例并发出血患者均因自身凝血功能紊乱所致出血。结论CVVH治疗用于MODS患者的救治安全可靠,并发症少,可有效缓解患者病情,保护脏器功能,是MODS患者救治中重要的治疗手段之一。治疗过程中患者耐受良好,血流动力学稳定,APACHEⅡ积分及C反应蛋白水平下降,两者的动态变化趋势有助于判断MODS患者的预后。
Objective To observe the APACHE Ⅱ score, C-reactive protein level, clinical efficacy and complications in patients with multiple organ failure (MODS) treated with continuous veno-venous hemofiltration (CVVH). Methods From January 2003 to December 2007, 34 patients with MODS who were treated with CVVH in our center were aged 19 to 91 years (mean, 64 ± 19 years) and APACHEⅡ score was 24.6 ± 3.4. The curative effect and course of CVVH were observed In patients with blood pressure, heart rate, body temperature, respiratory and other vital signs, monitoring of liver and kidney function, while observing CVVH treatment of complications. Results Of the 34 patients who survived for more than 14 days, 25 (73.6%) survived, and 10 patients (29.4%) eventually survived. All patients had renal failure and were significantly improved after CVVH. Survival group age [(61 ± 20) years old] was significantly lower than death group [(72 ± 16) years old], P <0.05, meanwhile respiratory failure, coagulation disorders and heart failure were significantly lower than death group. All patients were well tolerated of CVVH. Blood pressure, heart rate and hemodynamics were stable in the course of treatment. The APACHE II score in survivors decreased significantly during the course of treatment. All 8 patients with concurrent hemorrhage had hemorrhage due to coagulation disorders . Conclusion The CVVH treatment is safe and reliable for patients with MODS, with fewer complications, which can effectively relieve the patient’s condition and protect the organ function. It is one of the important treatment modalities for patients with MODS. In the course of treatment, patients with well-tolerated, hemodynamic stability, APACHE Ⅱ score and C-reactive protein levels decreased, the trend of the two changes will help determine the prognosis of patients with MODS.