| 摘要: |
| ［摘要］ 目的 探讨连续性血液净化治疗(continuous blood purification，CBP)对多器官功能障碍综合征(multiple organ dysfunction syndrome，MODS)凝血功能的影响。方法 MODS患者39例，其中男21例，女18例，年龄40～97岁，均符合MODS诊断标准；予高容量连续性静脉-静脉血液滤过(high volume continuous venovenous hemofiltration，HV-CVVH)模式治疗；于CBP前、CBP开始后4、12、24、48、72 h及CBP结束后6、24 h测定心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心排血量指数(cardiac index, CI)、氧合指数(PaO2/FiO2)、凝血酶原时间(prothrombirtime，PT)、部分凝血酶原时间(activated partial thromboplast in time，APTT)、纤维蛋白原(fibrinogen，FIB)及血小板(platelet count, PLT)变化；治疗后24、48、72 h行急性生理功能和慢性健康状况(APACHEⅡ)评分，同时以未行CBP治疗的MODS患者25例作对照。结果 与CBP前比较, PaO2/FiO2、CI在CBP开始后4 h明显升高(P<0.05)；CBP治疗组患者机械通气及血管活性药物使用时间明显缩短(P<0.05)，APACHEⅡ评分及病死率均有下降(P<0.05)，但低分子肝素抗凝组与无肝素组之间差异无统计学显著意义(P>0.05)。结论 CBP能改善血流动力学，改善氧合功能，维持患者凝血-纤溶系统的平衡，从而起到防治MODS的作用。 |
| 关键词: 连续性血液净化 多脏器功能障碍综合征 凝血功能障碍 |
| DOI：10.3969/j.issn.1674-3806.2009.10.22 |
| 分类号:R 459.5 |
| 基金项目: |
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| Effects of continuous blood purification on coagulation function in patients with multiple organ dysfunction syndrome |
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XIONG Bin, LIN Yong-jun
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Department of Medical Intensive Care Unit, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To investigate the effects of continuous blood purification(CBP) on coagulation function in patients with multiple organ dysfunction syndrome(MODS). Methods Thirty-nine patients with MODS(21 males，18 females)aged 40～97years received CBP.All patients met the criteria of MODS. High volume continuous venovenous hemofiltration(HV-CVVH)was performed. MAP, HR, CVP, cardiac index, PaO2/FiO2 , PT, APTT, FIB, PLT were measured and recorded before (baseline)and at 4、12、24、48 h and 72 h after CBP.APACHEⅡ score were recorded before (baseline)and at 24、48 h and 72 h after CBP. There was control group which composed of twenty-five patients with MODS treated with conventional methods without CBP.Results Compared with the baseline values before CBP PaO2/FiO2 and cardiac index were significantly increased at 4 h after CBP (P<0.05).The time of mechanical ventilation and the use of vasoactive agents were decreased in group with CBP treatment (P<0.05).APACHEⅡ score were significantly decreased after CBP(P<0.05). There was no significant change between low-molecular-weight heparin group and group without heparin (P>0.05).Conclusion CBP can improve hemodynamics and oxygenation function, keep the balance of the coagulation-fibrinolysis system, so that CBP therapy is effective for patients with MODS. |
| Key words: Continuous blood purification Multiple organ dysfunction syndrome Coagulation disorder |
