高容量血液滤过在老年多器官功能障碍综合征中的应用

目的观察高容量血液滤过（HVHF）治疗老年多器官功能障碍综合征（MODS）的疗效及安全性。方法老年MODS患者58例，采用HVHF治疗，观察治疗前后血液生化、血气分析、氧合指数、平均动脉压（MAP）及急性生理学和慢性健康状况Ⅱ评分（APACHE Ⅱ scores）的变化。结果HVHF治疗后患者电解质紊乱和酸碱失衡纠正，肾功能、血气、氧合指数改善。MAP上升，APACHEⅡ评分明显下降。所有患者对HVHF治疗均耐受良好，HVHF过程中血流动力学稳定，未发现明显的副作用。结论HVHF治疗除了能清除毒素和纠正电解质酸碱失衡以外，还能明显改善心肺功能和血气．应用于老年MODS患者是安全有效的。

Application of High Volume Hemofiltration in Elderly Patients with Multiple Organ Dysfunction Syndrome

Objective To investigate the effect and safety of high volume hemofihration（HVHF） in elderly patients with multiple organ dysfunction syndrome （MODS）. Methods Fifty-eight patients with MODS, aged 65-78 years old, were treated by HVHF. APACHE Ⅱ scores were evaluated, blood urea nitrogen （ BUN）, serum creatinine （ Scr）, natrium （ Na^＋ ） , kalium （ K^＋ ）, chlorine （ Cl^- ）, bicarbonate （ HCO^3- ）, carbon dioxide partial pressure （ PaCO2 ）, oxygen pressure （ PaO2 ）, oxygenation index and mean arterial pressure （MAP） were measured before and after the treatment. Results After treatment, blood electrolyte and acid base disorder improved, the levels of BUN, Scr, PaCO2 and APACHE Ⅱ scores decreased significantly, HCO3-, MAP and oxygenation index increased significantly. HVHF was well tolerated in all the patients. The haemodynamic variables were stabilized during HVHF.No obvious side-effect relate to HVHF was found. Conclusion HVHF can increase PaO2 and oxygenation index,decrease PaCO2 , improve heart and lung function as well as clear toxin, ameliorate blood electrolyte disturbances and acid-base imbalance. HVHF therapy was safe and effective for elderly patients with MODS.