静脉-静脉血液滤过透析对MODS患者血流动力学及氧代谢的影响

    Influence of veno-venous hemodiafiltration on hemodynamics and oxygenation in patients with multiple organ dysfunction syndrome

    • 摘要: 目的: 探讨静脉-静脉血液透析滤过(VVHDF)对多器官功能障碍综合征(MODS)患者血流动力学及氧代谢的影响。方法: 24例MODS患者经股静脉留置单针双腔导管,使用Hospal BSM 22 SC血滤系统行床边VVHDF治疗,治疗期间留置Swan-Ganz导管监测VVHDF治疗前后血流动力学变化、动脉和混合静脉血气变化,并计算氧代谢指标。结果: VVHDF治疗6 h后心率、右心房压、平均肺动脉压、肺动脉嵌顿压、肺血管阻力指数均较治疗前明显下降(P<0.001),平均动脉压、体血管阻力指数、动脉血氧分压、动脉血氧饱和度、动脉血氧含量、氧输送和氧消耗均显著增加(P<0.01~P<0.001);而心脏指数、血红蛋白、动脉血二氧化碳分压、混合静脉血氧分压、混合静脉血氧饱和度、混合静脉血氧含量、氧摄取率在VVHDF治疗前后均无明显改变(P>0.05)。结论: VVHDF用于MODS的治疗能改善MODS患者的全身血流动力学状况,提高氧供。

       

      Abstract: Objective: To explore the effects of veno-venous hemodiafiltration on hemodynamics and oxygenation in patients with multiple organ dysfunction syndrome(MODS).Methods: In 24 patients with MODS,a double lemen catheter was put into the femoral vein,and the VVHDF was performed with the Hospal BSM22 SC.Hemodynamics,blood gas and oxygenation were measured or calculated at scheduled intervals by use of Swan-Ganz catheters.Results: The heart rate,right atrium pressure,mean pulmonary arterial pressure,pulmonary arterial wedge pressure,index of pulmonary vascular resistence decreased significantly(P<0.001 respectively) compared with those before VVHDF;the mean arterial pressure,index of systemic vascular resistence,partial pressure of arterial blood oxygen,arterial blood oxygen saturation,arterial blood oxygen content,oxygen delivery and oxygen consumption increased significantly(P<0.01~P<0.001),and the cardiac index,blood hemoglobin,partial pressure of arterial blood carbon dioxide,partial oxygen pressure in mixed venous blood,venous oxygen saturation,venous oxygen content and oxygen extraction ration did not change after treatment(P>0.05).Conclusions: VVHDF can improve the condition of hemodynamics and oxygen supply.

       

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