中国血液净化

›› 2005, Vol. 4 ›› Issue (9): 491-493.

• 论著 • 上一篇    下一篇

连续性血液透析滤过在MODS患者治疗中的临床疗效

王建文 彭佑铭 陈 星 吴 鸿   

  1. 410011 长沙，中南大学肾脏病研究所 中南大学湘雅二医院血液净化中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-09-12 发布日期:2005-09-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-09-12 Published:2005-09-12

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摘要： 目的 观察连续性血液透析滤过在治疗 MODS患者的临床疗效.及其容量平衡的情况。方法 中南大学湘雅二医院20例MODS患者行床旁CBP治疗，采用Aquarius机器、AV600ｓ透析膜行床旁连续性静脉-静脉血液透析滤过(CVVHDF)治疗,置换液流量2～4L/h, 透析液流量4～6L/h，治疗时间6～10h/天, 观察治疗前、后患者血清尿素氮(BUN)、肌酐(SCr)、尿酸(UA)及血清电解质钾、钠、氯、钙、磷及二氧化碳结合力的变化,比较设定治疗剂量与实际治疗剂量,设定净超滤量与实际净超滤量的差值。结果 20例患者均很好地耐受治疗。治疗后BUN、SCr及Ua下降率分别为(42±13)%、(36±9)%及(52±11)%,血清钾、钠、氯、钙及二氧化碳水平无显著变化，血磷水平明显下降（P＜0.01）。设定治疗量为(47.2±8.1)L,而实际治疗量为(45.8±6.7)L,误差率为2.9%(中位数,95%范围0.3%～8.3%)。设定净超滤量为(3112±1002)ml,实际净超滤量为(2921±927)ml,误差率为6.8%(中位数,95%范围2.9%～9.9%)。总的容量误差率为0.51%(中位数,95%范围0.21%～0.96%)。结论 连续性血液透析滤过能有效用于MODS患者的救治，毒素清除能力强，能保持水、电解质及酸碱平衡，很好地保持容量平衡。

关键词: 连续性血液净化, 多器官功能不全综合征, 容量平衡

Abstract: Objective To observe the therapeutic effect of continuous veno-venous hemodiafiltration (CVVHDF) in multiple organ dysfundian syndrome (MODS) patients, and evaluate the degree of accuracy of fluid balance. Method Twenty hospitalized patients of MODS in Second XianYa Hospital were treated with corrtinous blood purification, continuous veno-venous hemodiafiltration (CVVHDF) was performed in these patients using Aquarius CBP machine and AV600s filters. The flow rate of substitution fluid and dialysate fluid was 2～4L/h and 4～6L/h, respectively, duration of each session of CBP lasted for 6～10 hours. Before and after each session of CVVHDF, serum levels of urea, creatinine, uric acid, CO2- combining power (C02CP)，and electrolytes such as potassium, sodium，calcium, phosphorus and chloride were evaluated. prescribed treatment dose, net ultrafiltration volume, and delivered treatment dose, delivered net ultrafiltration volume were recorded. Result All the patients tolerated CVVHDF therapy well. Reduction rate of serum urea, creatinine, uric acid after CVVHDF were (42±13)%、(36±9)% and (52±11)%, respectively. Serum electrolytes levels were maintained in stable range except phosphorus .The percentage of difference between prescribe dose (47.2±8.1) L and delivered dose (45.8±6.7) L was 2.9% (median, 95% range 0.3%～8.3%). The percentage of difference between prescribed net ultrfiltration volume (3112±1002)ml and delivered net ultrafiltration volume (2921±927) ml was 6.8%(median, 95% range 2.9%～9.9%). The deviation rate of total volume control was 0.51% (median, 95% range 0.21%～0.96%). Conclusion CVVHDF is a good method for the treatment of MODS patients, its apability of toxin clearance is strong, and can keep the bacance of water-electrolyte and acid-base.

Key words: Multiple organ dysfunation syndrome MODS, Volume control

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