摘要
目的:探讨血浆置换(PE)联合连续静脉-静脉血液滤过(CVVH)的血液净化疗法在产科多器官功能障碍综合征(MODS)抢救过程中的价值。方法:8例产科MODS患者在常规治疗基础上行PE联合CVVH治疗,比较治疗前后白陶土部分凝血活酶时间(APTT)、血小板(PLT)、血肌酐(Cr)、总胆红素(TBIL)、丙氨酸转移酶(ALT)和谷草转氨酶(AST)、氧合指数(PaO2/FiO2)、血白细胞(WBC)、中心静脉压(CVP)的变化。根据A-PACHE-Ⅱ评分计算出可能死亡率,并与实际死亡率对比。结果:8例患者中6例痊愈,2例死亡。患者的可能死亡率(73.6%)显著高于实际死亡率(25.0%)。联合治疗后APTT[(48.3±21.2)s]显著缩短,CVP[(8.0±2.1)cm H2O]、TBIL[(66.0±56.4)μmol/L]、血Cr[(111.0±84.5)μmol/L]、血白细胞[(16.8±5.6)×109/L]均明显下降,PLT计数[(142.2±115.0)×109/L]、PaO2/FiO2[(342±76.3)mmHg]均明显升高(P均<0.05)。结论:PE联合CVVH治疗可显著改善产科MODS患者的临床症状,有效改善脏器功能。
Objective：To study the effect of plasma exchange（PE） and continuous venous-venous hemofiltration （CVVH） in the treatment of obstetric related multiple organ dys- function syndrome（MODS）. Methods ：8 patients with MODS were treated with PE and CVVH treatment except general management, CVP, APTF, platelet count, blood creatinine, WBC, total bilirubin, ALT, AST and oxygenation index of the patients were determined before and after treatment. The possible mortality calculated by APACHE- 11 scores was compared with the actual mortality. Results ：6 cases were cured and 2 cases died. The actual mortality was significantly lower than the calculated mortality（25.0% vs 73.6% ）. The data showed that APTT were decreased significantly following PE and CVVH （48.3 ± 21.2s）. So did the CVP （ 8.0 ± 2. 1 cm H20 ）, blood creatinine （ 111.0± 84.5 txmol/L）, total bilirubin （ 66.0 ± 56.4 μmol/L ） and WBC [ （ 16.8±5.6 ） × 10^9/L ] of the patients （ P 〈 0.05 ）. Oxygenation index increased significantly （ 342±76.3 mmHg）. So did the platelet count [ （ 142.2 ± 115.0 ）× 10^9/L 3. Conclusions： The combination of PE and CVVH can significantly improve the clinical symptoms and organ function of obstetric patients with MODS.
出处
《现代妇产科进展》
CSCD
2013年第5期353-356,共4页
Progress in Obstetrics and Gynecology
关键词
多器官功能障碍综合征
连续静脉一静脉血液滤过
血浆置换
产妇死亡率
危重病
Multiple organ dysfunction syndrome（MODS）
Continuous venous-venous hemofiltration （CVVH）
Plasma exchange （ PE ）
Maternal mortality i Critical illness
