连续性血液净化救治重症-内科急危重症杂志.DOC

连续性血液净化救治重症恶性疟疾的临床研究 南通市第三人民医院急诊科 葛志华通信作者：葛志华，Email：gezhihua1976@163.com，徐建如，邱斌，钱骏，韩旭东（江苏南通， 通信作者：葛志华，Email：gezhihua1976@163.com 【摘要】 目的 探讨连续性血液净化(CBP)对重症输入性恶性疟疾合并多器官功能障碍综合征(MODS)的治疗价值。方法 回顾性分析2011年2月至2016年3月入住我院ICU采用CBP治疗的20例重症输入性恶性疟疾合并MODS患者的临床资料。记录CBP前后临床、生化及炎症指标的变化，统计病死率和并发症。结果 18例痊愈或好转，2例死亡。与治疗前比较，经CBP治疗后患者体温、呼吸、心率、氧合指数、格拉斯哥昏迷评分、急性生理学与慢性健康状况评分系统Ⅱ评分、序贯性器官功能估计评分明显改善(P＜0.05)，血PH值、碱剩余显著上升(P＜0.05)，尿素氮、血肌酐、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、动脉血乳酸及C反应蛋白、降钙素原显著下降(P＜0.05)。CBP期间血流动力学稳定，未出现明显并发症。结论 CBP可安全有效地支持重症恶性疟疾合并MODS患者的重要脏器功能，减轻全身炎症反应，值得临床推广使用。 【关键词】 恶性疟疾；重症；连续性血液净化；多器官功能障碍综合征 Clinical study of continuous blood purification in treatmeat of severe falciparum malaria GE Zhi-hua*，XU Jian-ru，QIU Bin，Qian Jun，Han Xu-dong. Department of Emergency，Third Affiliated Hospital of Nantong University，Nantong 226006，China 【Abstract】Objective To investigate the value and efficacy of continuous blood purification(CBP) for treatment of severe imported falciparum malaria complicated by multiple organ dysfunction syndrome(MODS). Methods The clinical data of 20 patients with severe imported falciparum malaria complicated by MODS undergoing continuous blood purification in our hospital from February 2011 to March 2016 were analyzed retrospectively.The clinical indicators, biochemical and inflammatory parameters were monitored before and after CBP.Prognosis and adverse effect were observed.Results Eighteen patients were cured or improved,and 2 died.Compared with those before CBP,body temperature,respiratory rate,heart rate,oxygenation index, glasgow coma scale,sequential organ failure assessment score were significantly improved(P＜0.05);blood pH value and base excess were significantly increased(P＜0.05);the levels of serum urea nitrogen,serum creatinine,alanine aminotransferase,aspartate aminotransferase,serum total bilirubin,arterial lactate,procalcitonin,C-reactive protein were significantly reduced after the treatment(P＜0.05).In the process of the treatment,hemodynamics was stable and no obvio