中国临床新医学
中國臨床新醫學
중국림상신의학
CHINESE JOURNAL OF NEW CLINICAL MEDICINE
2015年
6期
534-537
,共4页
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
高容量血液濾過%血漿置換%橫紋肌溶解%多器官功能障礙綜閤徵
고용량혈액려과%혈장치환%횡문기용해%다기관공능장애종합정
High volume hemofiltration(HVHF)%Plasma exchange(PE)%Rhabdomyolysis(RM)%Multiple organ dysfunction syndrome( MODS)
目的：观察高容量血液滤过（ high volume hemofiltration， HVHF ）联合血浆置换（ plasma ex-change，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。
目的：觀察高容量血液濾過（ high volume hemofiltration， HVHF ）聯閤血漿置換（ plasma ex-change，PE）治療橫紋肌溶解伴多器官功能障礙綜閤徵的臨床療效。方法選取2010-01～2014-09在開封市中心醫院確診為橫紋肌溶解伴多器官功能障礙綜閤徵的患者20例，隨機分為HVHF組和HVHF聯閤PE組，每組各10例。比較兩組患者治療5 d後生命體徵、急性生理學及慢性健康狀況評分繫統Ⅱ（ APACHEⅡ）評分、血肌酐、尿素氮、乳痠脫氫酶、肌痠燐痠激酶、穀丙轉氨酶、穀草轉氨酶、肌紅蛋白、腫瘤壞死因子-α（ TNF-α）、白細胞介素-1（IL-1）、白細胞介素-6（IL-6）等指標變化。結果與治療前相比，兩組患者在治療5 d後生命體徵較治療前穩定，APACHEⅡ評分、血肌酐、尿素氮、乳痠脫氫酶、肌痠燐痠激酶、穀丙轉氨酶、穀草轉氨酶、肌紅蛋白、TNF-α、IL-1、IL-6下降明顯（ P＜0.05）。 HVHF＋PE組較HVHF組肌紅蛋白下降更為明顯（ P＜0.01），而血肌酐、尿素氮、乳痠脫氫酶、肌痠燐痠激酶、穀丙轉氨酶、穀草轉氨酶、TNF-α、IL-1、IL-6的降低無明顯差異（ P＞0.05）。結論 HVHF與PE均能有效清除橫紋肌溶解伴多器官功能障礙綜閤徵患者體內的炎癥因子及肌紅蛋白，改善患者的臨床癥狀及預後，而PE清除肌紅蛋白的篩選繫數明顯高于血液濾過，故治療橫紋肌溶解伴多器官功能障礙綜閤徵可優先選擇HVHF聯閤PE。
목적：관찰고용량혈액려과（ high volume hemofiltration， HVHF ）연합혈장치환（ plasma ex-change，PE）치료횡문기용해반다기관공능장애종합정적림상료효。방법선취2010-01～2014-09재개봉시중심의원학진위횡문기용해반다기관공능장애종합정적환자20례，수궤분위HVHF조화HVHF연합PE조，매조각10례。비교량조환자치료5 d후생명체정、급성생이학급만성건강상황평분계통Ⅱ（ APACHEⅡ）평분、혈기항、뇨소담、유산탈경매、기산린산격매、곡병전안매、곡초전안매、기홍단백、종류배사인자-α（ TNF-α）、백세포개소-1（IL-1）、백세포개소-6（IL-6）등지표변화。결과여치료전상비，량조환자재치료5 d후생명체정교치료전은정，APACHEⅡ평분、혈기항、뇨소담、유산탈경매、기산린산격매、곡병전안매、곡초전안매、기홍단백、TNF-α、IL-1、IL-6하강명현（ P＜0.05）。 HVHF＋PE조교HVHF조기홍단백하강경위명현（ P＜0.01），이혈기항、뇨소담、유산탈경매、기산린산격매、곡병전안매、곡초전안매、TNF-α、IL-1、IL-6적강저무명현차이（ P＞0.05）。결론 HVHF여PE균능유효청제횡문기용해반다기관공능장애종합정환자체내적염증인자급기홍단백，개선환자적림상증상급예후，이PE청제기홍단백적사선계수명현고우혈액려과，고치료횡문기용해반다기관공능장애종합정가우선선택HVHF연합PE。
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, APACHEⅡscore, serum creatinine, blood urea nitrogen,lactate de-hydrogenase, creatine kinase, alanine aminotransferase, aspartate aminotransferase, myoglobin, tumor necrosis fac-tor-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 pre-treatment.APACHE Ⅱscore, serum creatinine, blood urea nitrogen, lactate dehydrogenase, creatine kinase, ala-nine 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 ser-um creatinine, blood urea nitrogen, lactate dehydrogenase, creatine kinase, alanine aminotransferase, aspartate ami-notransferase, 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.
