连续性血液净化在治疗多器官功能障碍综合征中的应用

发布时间：2018-05-05 09:10

本文选题：多器官功能障碍综合征 + 连续性血液净化　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景连续性血液净化(continuous blood purification CBP)通过弥散、对流、吸附等方式除去患者体内某些致病物质,从而治疗疾病。CBP符合生理状态,能根据需要不断调节液体平衡,通过吸附、对流机制,清除血液中的炎症介质和溶质,清除率较高[1-2],在治疗多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)方面具备突出疗效。目的通过回顾性分析在临床常规治疗基础上接受连续性血液净化治疗的MODS患者与只进行临床常规治疗的MODS患者治疗前后各项指标的对比,以探讨多器官功能障碍综合征患者应用连续性血液净化的疗效。方法选取南阳市中心医院2014年1月到2016年9月进行临床常规治疗基础上接受连续性血液净化治疗的60例MODS患者分为A组,将南阳市中心医院2014年1月到2016年9月只进行临床常规治疗而未接受连续性血液净化治疗的60例MODS患者分为B组,观察两组患者治疗前后的Marshall评分、血尿素氮(BUN)、电解质水平(K+)、血肌酐(Scr)、二氧化碳结合力(CO2CP)、N末端前脑利钠肽(NT-proBNP)、治疗成功率和ICU住院天数等临床指标评价临床疗效。结果1、对A、B两组病例治疗前的Marshall评分、血尿素氮、电解质水平、血肌酐、二氧化碳结合力、N末端前脑利钠肽比较采用独立样本T检验的统计学方法进行分析,A、B两组病例治疗前的上述指标相比,P0.05,差异无统计学意义。2、对A、B两组病例治疗后的Marshall评分、血尿素氮、电解质水平、血肌酐、二氧化碳结合力、N末端前脑利钠肽、ICU住院天数采用独立样本T检验的统计学方法进行分析,A、B两组病例治疗后的上述指标相比,P0.01,差异有统计学意义。3、对A组病例治疗前后的Marshall评分、血尿素氮、电解质水平、血肌酐、二氧化碳结合力、N末端前脑利钠肽采用配对样本T检验的统计学方法进行分析,A组病例治疗前后的上述指标相比,P0.01,差异有统计学意义。4、接受连续性血液净化治疗的MODS患者中治愈出院43例(71.7%),死亡17例(28.3%);未接受连续性血液净化治疗的MODS患者中治愈出院19例(31.7%),死亡41例(68.3%),对A、B两组患者治疗后转归情况采取X2检验,P0.01,差异有统计学意义。5、A组病例CBP治疗总时间在22~90小时之间,平均CBP治疗时间为43.82±16.10小时。结论1、在临床常规治疗的基础上,早期应用连续性血液净化治疗,能有效改善多器官功能障碍综合征患者的病情,有利于预后。2、连续性血液净化治疗是治疗多器官功能障碍综合征的有效手段,对改善患者的病情,降低患者的病死率,加速患者的康复,有重要意义,有重要的临床应用及推广价值。
[Abstract]:Background continuous blood purification CBP) removes some pathogenic substances from the body of the patient by means of diffusion, convection and adsorption, so that the treatment of disease .CBP is in accordance with physiological state, and can constantly adjust the liquid balance according to the need, through adsorption, convection mechanism, etc. The clearance rate of inflammatory mediators and solutes in the blood is higher [1-2], which has a remarkable curative effect in the treatment of multiple organ dysfunction syndrome (MODS). Objective to analyze retrospectively the indexes of MODS patients who received continuous blood purification therapy on the basis of clinical routine therapy and MODS patients who received only routine clinical treatment before and after treatment. To investigate the effect of continuous blood purification in patients with multiple organ dysfunction syndrome. Methods from January 2014 to September 2016, 60 patients with MODS received continuous blood purification therapy in Nanyang Central Hospital from January 2014 to September 2016. From January 2014 to September 2016, 60 patients with MODS were divided into two groups (group B) who received only routine clinical treatment without continuous blood purification therapy. The Marshall scores of the two groups were observed before and after treatment. Blood urea nitrogen bun, electrolyte level, creatinine, carbon dioxide binding capacity (CO2CPN), N-terminal forebrain natriuretic peptide (NT-proBNPN), success rate of treatment and hospitalization days of ICU were evaluated. Results 1. The Marshall score, blood urea nitrogen, electrolyte level, serum creatinine and serum creatinine were measured in group A and B before treatment. The comparison of N-terminal forebrain natriuretic peptide with carbon dioxide binding power was analyzed by independent sample T test. The above indexes in two groups were compared with that before treatment (P 0.05). There was no significant difference between the two groups (P 0.05). The Marshall scores of two groups were evaluated after treatment. Blood urea nitrogen, electrolyte level, blood creatinine, The Inpatient days of N-terminal forebrain natriuretic Peptide in ICU with carbon dioxide binding Power and N-terminal brain natriuretic Peptide in ICU were analyzed by independent sample T test. The above indexes of two groups were compared with that of P0.01 after treatment, and the difference was statistically significant. 3. The treatment of group A cases was done. Marshall scores before and after treatment, Blood urea nitrogen, electrolyte level, blood creatinine, The N-terminal forebrain natriuretic peptide of carbon dioxide binding force was analyzed by paired sample T test. The above indexes before and after treatment in group A were compared with that in group A (P 0.01), the difference was statistically significant. 4. The patients received continuous blood purification therapy. 43 cases of MODS were cured and discharged 43 cases were cured, 17 cases died, 19 cases were cured and discharged from MODS patients without continuous blood purification therapy, 41 cases died 68.3%. X2 test P0.01 was used to evaluate the prognosis of two groups of patients with MODS, the difference was statistically significant. The total time of CBP treatment in group A was between 22 and 90 hours. The average CBP treatment time was 43.82 卤16.10 hours. Conclusion 1. On the basis of routine clinical treatment, early application of continuous blood purification therapy can effectively improve the condition of patients with multiple organ dysfunction syndrome. Continuous blood purification therapy is an effective method for the treatment of multiple organ dysfunction syndrome. It is of great significance to improve the patient's condition, reduce the mortality rate of the patient, and accelerate the recovery of the patient. It has important clinical application and promotion value.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

【参考文献】

中国期刊全文数据库前10条

1 魏学武;孟红;孙永刚;谢春岩;;连续性血液净化在重症监护病房多器官功能障碍综合征患者中的应用价值[J];中国药物经济学;2015年12期

2 李叶戌子;缪时星;张帅;彭灵君;;重症患者伴凝血功能障碍行连续性肾脏替代治疗效果观察[J];中国乡村医药;2015年24期

3 陈晓梅;;严重创伤后急性肾损伤行连续性肾替代治疗对凝血功能及炎症介质的影响[J];创伤外科杂志;2015年06期

4 周刊;陆恩峰;肖琦;何建静;徐建明;方如美;罗仕云;张新华;;血浆置换联合连续性血液净化在热射病导致多器官功能障碍综合征的救治分析[J];中国中西医结合肾病杂志;2015年08期

5 鲍江波;刘艳姝;杜娟;马艳芳;王艳秋;;连续性血液净化对SIRS/SEPSIS合并急性肾衰患者血清PCT、TNF-α、IL-6、IL-10等炎症因子水平的影响[J];中国医学创新;2015年16期

6 胡桂华;鲍海咏;;多器官功能障碍综合征的研究进展[J];中国临床研究;2014年12期

7 马健平;;1例连续性血液净化治疗烧伤合并急性肾衰的药学监护[J];中国药业;2014年17期

8 郭峻氚;陈东;向东明;肖东;;41例重症胰腺炎合并多器官功能障碍综合征早期行连续性肾脏替代治疗的临床效果观察[J];新疆医学;2014年07期

9 刘璇;唐忠平;林凤;;血液灌流联合连续性肾脏替代治疗多器官功能障碍综合征的疗效观察[J];当代医学;2014年08期

10 崔畅;肖正睿;戴启盈;翁亚丽;;重症感染患者持续肾脏替代治疗效果的Meta分析[J];江苏医药;2014年02期