连续静脉-静脉血液滤过对高龄老年多器官功能衰竭患者的疗效

Efficacy of continuous venous-venous hemofiltration in treatment of the elderly with multiple organ failure

摘要:

目的 探讨连续静脉-静脉血液滤过(CVVH)治疗高龄老年多器官衰竭(MOFE)患者的效果与安全性。方法 回顾性分析2010年1月至2020年12月东部战区总医院老年病房诊治的多器官功能衰竭33例患者的临床资料。按照存活时间是否超过15d,分为存活组(18例)和死亡组(15例)。收集患者的年龄、衰竭器官数量、血生化指标、动脉血气、治疗方法及死亡时间等指标。采用SPSS 22.0软件进行数据分析。结果 所有患者均为股静脉置管,有4例发生导管感染。存活组与死亡组患者的年龄、CVVH前的血尿素氮、肌酐、电解质、脑利钠肽前体、动脉血pH值、全血剩余碱比较,差异均无统计学意义(均P>0.05)；存活组与死亡组乳酸[(2.32±1.17)和(5.00±4.35)mmol/L]、24h尿量[(501.17±229.62)和(220.33±191.68)ml]、衰竭器官个数[(3.33±1.14)和(4.33±1.15)个]比较,差异均有统计学意义(均P<0.05)。CVVH治疗前后尿素氮[(34.27±13.54)和(15.77±9.15)mmol/L]、血肌酐[(347.57±170.22)和(165.55±89.32)μmol/L]、脑利钠肽前体[(2128.27±1416.08)和(1181.86±1 305.17)pmol/L]、血钾[(4.78±1.03)和(4.12±0.56)mmol/L]、动脉血pH值[(7.28±0.12)和(7.33±0.12)]比较,差异均有统计学意义(均P<0.05),治疗前后血钠、钙、磷、全血剩余碱及乳酸变化不明显(P>0.05)。结论 CVVH治疗有助于改善高龄老年多器官功能衰竭患者的预后,能明显减轻高龄患者心脏负荷、加快小分子毒素的清除、维持电解质和酸碱度的平衡。

Abstract:

Objective To investigate the efficacy and safety of continuous venous-venous hemofiltration (CVVH) in the treatment of multiple organ failure in the elderly (MOFE). Methods Clinical data of 33 elderly patients with MOFE who underwent CVVH treatment in our hospital from January 2010 to December 2020 were collected and retrospectively analyzed in this study. According to their survival time longer than 15 d or not, they were divided into survival group (n=18) and death group (n=15). Their age, number of failed organs, blood biochemical indicators, arterial blood gas parameters, treatment methods, death time and other indicators were analyzed. SPSS statistics 22.0 was used for statistical analysis. Results All patients had femoral vein catheterization, and 4 cases experienced catheter infection. There were no significant differences in age, serum levels of urea nitrogen, creatinine, electrolytes and pro-brain natriuretic peptide, arterial blood pH value, and residual alkali between the two groups (all P>0.05). Obvious differences were seen in lactic acid level [(2.32±1.17) vs (5.00±4.35) mmol/L], 24-hour urine volume [(501.17±229.62) vs (220.33±191.68) ml] and number of failed organs [(3.33±1.14) vs (4.33±1.15), all P<0.05]. Urea nitrogen [(34.27±13.54) vs (15.77±9.15) mmol/L], serum creatinine [(347.57±170.22) vs (165.55 ± 89.32) μmol/L], pro-brain natriuretic peptide [(2 128.27±1 416.08) vs (1 181.86±1 305.17) pmol/L], blood potassium [(4.78±1.03) vs (4.12±0.56) mmol/L], arterial blood pH value [(7.28±0.12) vs (7.33±0.12)] were statistically significant before and after CVVH treatment (all P<0.05). But no such differences were found in blood sodium, calcium, phosphorus, residual alkali and lactic acid before and after treatment (P>0.05). Conclusion CVVH treatment is significantly helpful for improving the prognosis, reducing the heart loading, accelerating the removal of small molecule toxins, and maintaining the balance of electrolytes and pH value in the elderly patients with MOFE.