中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (11): 608-611.doi: 10.3969/j.issn.1671-4091.2013.11.00

• 临床研究 • 上一篇    下一篇

连续血液净化救治HELLP综合征合并MODS的回顾性分析

赵士兵,何先弟,汪华学,段立彬,邹琪,余刚   

  1. 蚌埠医学院第一附属医院重症医学科
  • 收稿日期:2013-06-06 修回日期:2013-08-23 出版日期:2013-11-12 发布日期:2013-11-12
  • 通讯作者: 何先弟 byyfyhxd@sina.com E-mail:byyfyhxd@sina.com
  • 基金资助:

    安徽省“十二五”临床重点培育专科建设项目(编号：01P44)

Retrospective analysis of continuous blood purification treatment effect of HELLP syndrome combined MODS

  • Received:2013-06-06 Revised:2013-08-23 Online:2013-11-12 Published:2013-11-12

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摘要： 【摘要】　目的 探讨连续血液净化(continuous blood purification,CBP)对HELLP综合征(hemolysis,elevated liver enzymes,and low platele syndrome )合并MODS的救治效果。方法 回顾性分析蚌埠医学院第一附属医院重症医学科收治的HELLP综合征合并MODS 患者15例，及时终止妊娠，在给予重症监护等内科综合治疗的同时，加用CBP治疗，统计分析患者在入科时、住院期间峰值和出科时的APPCHEⅡ评分、心率、呼吸、MAP、氧合指数、LDH、转氨酶、总胆红素、血小板计数等各项理化指标变化，以及患者平均住ICU时间、机械通气时间和CBP次数。结果 15例患者中12例治愈出院，平均CBP次数(4.2±1.6)次、机械通气时间(4.9±2.1,n=9)d、住ICU时间(7.3±2.3)d；患者入科时各脏器功能指标较差，住院期间又进一步加重直至达到最高峰，经过连续CBP治疗，患者神志转清、呼吸平稳、正常饮食，逐步消除了头痛头晕、视物模糊、黄疸、恶心、出血及少尿等临床症状；各种理化指标比入科时和峰值均有较大程度的好转，差异有统计学意义p<0.05，如TBIL、BUN、CR等下降明显，LDH、PT、肝酶、血小板计数恢复较快，贫血已得到纠正，平均动脉压已恢复正常；APACHEII评分在出科时为(12.1±9.8)分，而入科时APACHEII评分(21.9±8.7)分，住院期间峰值(32.5±6.4)分，出科时分别较入科时和住院峰值有显著下降，有显著性差异，p<0.05，CBP治疗效果明显。结论 连续血液净化能够改善患者的临床症状，逆转迅速恶化的各项理化指标，提高治愈率，是救治HELLP综合征合并MODS患者的有效手段。

关键词: 连续血液净化, HELLP综合征, 多脏器功能障碍综合征

Abstract: 【Abstract】 Objective To investigate the effect of continuous blood purification(CBP) for the treatment of HELLP syndrome combined MODS. Methods Retrospective analysis of 15 patients, timely termination of pregnancy, given comprehensive treatment and other medical intensive care at the same time, plus CBP treatment,the clinical data with the discharge admission and peak were statistically analyzed and compared,these projects included: APPCHEⅡscore,HR, RR, MAP, oxygenation index, LDH, ALT, total bilirubin, platelet count, and other physical and chemical indicators, as well as patients with an average days of ICU stay, days of mechanical ventilation and CBP times. Results 15 patients, 12 had been cured, CBP (4.2±1.6) times, days of mechanical ventilation (4.9±2.1,n=9)d, days of ICU stay (7.3±2.3)d; patients with poor organ function at admission, during hospitalization further increase until it reaches peak, after CBP treatment, these patients turned clear consciousness, breathed steady, normal diet, gradually eliminated the headache, dizziness, blurred vision, nausea, jaundice, bleeding ,oliguria and other symptoms; compared with admission and peak, various physical and chemical indicators of the discharge had a greater degree of improvement, the difference was statistically significant p<0.05,as TBIL, BUN, CR, etc. decreased significantly, LDH, PT, liver enzymes, low platelet count recovery faster, anemia had been corrected, MAP had returned to normal;APACHEII score discharge(12.1±9.8)points, admission(21.9±8.7)points,and peak(32.5±6.4)points, compared respectively, There were statistically significant difference, p<0.05, CBP treatment significantly. Conclusion The treatment with CBP can reduce the clinical symptoms, reverse rapidly deteriorating physical and chemical indicators, improve the cure rate and can be an effective treatment of HELLP syndrome combined MODS.

Key words: continuous blood purification, HELLP syndrome, multiple organ dysfunction syndrome