摘要
目的 比较连续性静脉-静脉血液滤过（CVVH）和连续性静脉-静脉血液透析滤过（CVVHDF）两种不同净化方式对多器官功能障碍综合征（MODS）患者临床疗效的差异.方法 采用前瞻性观察性研究方法,选择2013年9月至2016年12月遵义医学院附属医院重症医学科收治的MODS患者70例,按治疗方法不同将患者分为两组,每组35例.CVVH组置换液及透析液流速均为1800 mL/h,CVVHDF组置换液和透析液流速均为2000 mL/h,两组血流速度均为150~180 mL/min.比较两组治疗前和治疗后24、48、72 h血肌酐（SCr）、尿素氮（BUN）、pH值、碳酸氢根（HCO3-）、辅助性T细胞（Th1、Th2）和Th1/2比值的差异.结果 随时间延长,两组治疗后SCr、BUN均较治疗前降低,治疗后72 h达最低,且CVVHDF组治疗后的变化程度较CVVH组更显著〔SCr（μmol/L）：150.62±32.09比177.47±31.41,BUN（mmol/L）：7.31±2.19比9.06±2.36,均P〈0.05〕,两组治疗后pH值、HCO3-呈先升高后降低的趋势,治疗后48 h达峰值,与治疗前比较差异有统计学意义〔CVVH组：pH值为7.42±0.08比7.25±0.10,HCO3-（mmol/L）为22.49±5.11比15.65±4.16;CVVHDF组：pH值为7.41±0.04比7.24±0.11,HCO3-（mmol/L）为23.24±4.78比15.65±4.16,均P〈0.05〕,治疗后72 h又有所降低（CVVH组：pH值、HCO3-分别为7.37±0.07、22.35±4.91,CVVHDF组pH值、HCO3-分别为7.38±0.06、22.53±4.58）,但仍明显高于治疗前,两组间各时间点比较差异均无统计学意义（均P〉0.05）.随治疗时间延长,两组治疗后Th1、Th1/2均逐渐升高,于治疗后72 h达高峰;Th2呈逐渐降低趋势,于治疗后72 h达最低,且治疗后CVVHDF组的变化较CVVH组更显著〔Th1（×10-2）：1.51±0.12比1.21±0.11,Th2（×10-2）：1.61±0.62比1.70±0.18,Th1/2：0.91±0.14比0.71±0.15,均P〈0.05〕.结论 CVVHDF和CVVH均能有效清除MODS患者体内的炎症介质和代谢产物,调整酸碱平衡并调节免疫功能,且CVVHDF较CVVH更为有效.
Objective To compare the clinical therapeutic effects of continuous veno-venous hemofiltration （CVVH） and continuous veno-venous hemodiafiltration （CVVHDF） for treatment of patients with multiple organ dysfunction syndrome （MODS）.Methods A prospective observation was conducted, seventy patients with MODS admitted to the Department of Critical Care Medicine of the Affiliated Hospital of Zunyi Medical College from September 2013 to December 2016 were enrolled, and they were divided into a CVVH group and a CVVHDF group according to different treatment, 35 cases in each group. In the CVVH group, the ultrafiltration fluid flow rate was set at 1800 mL/h, while in the CVVHDF group, the flow rate was set at 2000 mL/h for both substitution fluid and dialysate, and the blood flow of the two groups was 150-180 mL/min. The changes of creatinine （SCr）, urea nitrogen （BUN）, pH value, HCO3-, helper T cell （Th1, Th2） and Th1/Th2 ratio were compared between the two groups before and after treatment for 24, 48 and 72 hours.Results With the extension of time, SCr, BUN were reduced in both groups after treatment compared to those before treatment, 72 hoursafter treatment they reached the lowest value, and the degree of change in CVVHDF group was more significant than that in CVVH group [SCr （μmol/L）： 150.62±32.09 vs. 180.41±30.52, BUN （mmol/L）： 7.31±2.19 vs. 9.06±2.36. allP 〈 0.05], after treatment; the pH value, HCO3- level in the two groups had a tendency at first elevated and then lowered, 48 hours after treatment they reached the peak values, compared with those before treatment, the differences were statistically significant [CVVH group： the pH value 7.42±0.08 vs. 7.25±0.10, HCO3- （mmol/L） was 22.49±5.11 vs. 15.65±4.16; CVVHDF group： pH value 7.41±0.04 vs. 7.24±0.11, HCO3- （mmol/L） 23.24±4.78 vs. 15.65±4.16, allP 〈 0.05], 72 hours after treatment, they began reduced （CVVH group： pH value, HCO3- were 7.39±0.09, 22.35±4.91 respectively, CVVHDF group： pH valu
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2017年第4期415-418,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
贵州省科技计划项目（黔科合SY字[2011]3025号）
