| 摘要: |
| ［摘要］ 目的 观察高容量血液滤过（high volume hemofiltration,HVHF）联合血浆置换（plasma exchange,PE）治疗横纹肌溶解伴多器官功能障碍综合征的临床疗效。方法 选取2010-01～2014-09在开封市中心医院确诊为横纹肌溶解伴多器官功能障碍综合征的患者20例，随机分为HVHF组和HVHF联合PE组，每组各10例。比较两组患者治疗5 d后生命体征、急性生理学及慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、血肌酐、尿素氮、乳酸脱氢酶、肌酸磷酸激酶、谷丙转氨酶、谷草转氨酶、肌红蛋白、肿瘤坏死因子-α（TNF-α）、白细胞介素-1（IL-1）、白细胞介素-6（IL-6）等指标变化。结果 与治疗前相比，两组患者在治疗5 d后生命体征较治疗前稳定，APACHEⅡ评分、血肌酐、尿素氮、乳酸脱氢酶、肌酸磷酸激酶、谷丙转氨酶、谷草转氨酶、肌红蛋白、TNF-α、IL-1、IL-6下降明显（P<0.05）。HVHF+PE组较HVHF组肌红蛋白下降更为明显（P<0.01），而血肌酐、尿素氮、乳酸脱氢酶、肌酸磷酸激酶、谷丙转氨酶、谷草转氨酶、TNF-α、IL-1、IL-6的降低无明显差异（P>0.05）。结论 HVHF与PE均能有效清除横纹肌溶解伴多器官功能障碍综合征患者体内的炎症因子及肌红蛋白，改善患者的临床症状及预后，而PE清除肌红蛋白的筛选系数明显高于血液滤过，故治疗横纹肌溶解伴多器官功能障碍综合征可优先选择HVHF联合PE。 |
| 关键词: 高容量血液滤过 血浆置换 横纹肌溶解 多器官功能障碍综合征 |
| DOI：10.3969/j.issn.1674-3806.2015.06.13 |
| 分类号:R 459.5 |
| 基金项目: |
|
| Clinical investigation of high volume hemofiltration combined with plasma exchange in rhabdomyolysis combined with multiple organ dysfunction syndrome |
|
WU Ji, ZHAO Jing-yu, WANG Nai-ping
|
|
Department of Hemodialysis, Kaifeng Central Hospital, Henan 475000, China
|
| Abstract: |
| ［Abstract］ Objective To investigate the clinical therapy of high volume hemofiltration(HVHF) combined with plasma exchange(PE) in patients with rhabdomyolysis(RM) combined with multiple organ dysfunction syndrome(MODS).Methods Twenty patients with RM combined with MODS were enrolled from January 2010 to September 2014 in our hospital and were randomly divided into two groups: HVHF group(n=10) and HVHF combined with PE group(n=10). The changes of the vital signs, APACHE Ⅱ score, serum creatinine, blood urea nitrogen,lactate dehydrogenase, creatine kinase, alanine aminotransferase, aspartate aminotransferase, myoglobin, tumor necrosis factor-α, interleukin-1 and interleukin-6 levels were compared between the two groups after the treatments for 5 days.Results The vital signs were more stable in both of the two groups after 5 days of the treatment compared with pretreatment. APACHE Ⅱ score, serum creatinine, blood urea nitrogen, lactate dehydrogenase, creatine kinase, alanine aminotransferase, aspartate aminotransferase, myoglobin, tumor necrosis factor-α, interleukin-1 and interleukin-6 levels were significantly declined in both of the two groups after the treatments for 5 days （P<0.05）. Myoglobin was significantly reduced in HVHF combined with PE group than that in HVHF group（P<0.01）. The levels of serum creatinine, blood urea nitrogen, lactate dehydrogenase, creatine kinase, alanine aminotransferase, aspartate aminotransferase, tumor necrosis factor-α, interleukin-1 and interleukin-6 were not significantly different between the two groups（P>0.05）.Conclusion The inflammatory factors and myoglobin are effectively eliminated in patients with RM combined with MODS by both HVHF and PE, which improve the clinical symtoms and prognosis of the patients. PE is obviously better than hemofiltration(HF) to remove myoglobin filter coefficients. HVHF combined with PE is the preferent method for treating RM combined with MODS. |
| Key words: High volume hemofiltration(HVHF) Plasma exchange(PE) Rhabdomyolysis(RM) Multiple organ dysfunction syndrome(MODS) |
