本文選題：多器官功能障礙綜合征 + 連續(xù)性血液凈化�。� 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景連續(xù)性血液凈化(continuous blood purification CBP)通過彌散、對流、吸附等方式除去患者體內(nèi)某些致病物質(zhì),從而治療疾病。CBP符合生理狀態(tài),能根據(jù)需要不斷調(diào)節(jié)液體平衡,通過吸附、對流機制,清除血液中的炎癥介質(zhì)和溶質(zhì),清除率較高[1-2],在治療多器官功能障礙綜合征(multiple organ dysfunction syndrome,MODS)方面具備突出療效。目的通過回顧性分析在臨床常規(guī)治療基礎(chǔ)上接受連續(xù)性血液凈化治療的MODS患者與只進行臨床常規(guī)治療的MODS患者治療前后各項指標的對比,以探討多器官功能障礙綜合征患者應(yīng)用連續(xù)性血液凈化的療效。方法選取南陽市中心醫(yī)院2014年1月到2016年9月進行臨床常規(guī)治療基礎(chǔ)上接受連續(xù)性血液凈化治療的60例MODS患者分為A組,將南陽市中心醫(yī)院2014年1月到2016年9月只進行臨床常規(guī)治療而未接受連續(xù)性血液凈化治療的60例MODS患者分為B組,觀察兩組患者治療前后的Marshall評分、血尿素氮(BUN)、電解質(zhì)水平(K+)、血肌酐(Scr)、二氧化碳結(jié)合力(CO2CP)、N末端前腦利鈉肽(NT-proBNP)、治療成功率和ICU住院天數(shù)等臨床指標評價臨床療效。結(jié)果1、對A、B兩組病例治療前的Marshall評分、血尿素氮、電解質(zhì)水平、血肌酐、二氧化碳結(jié)合力、N末端前腦利鈉肽比較采用獨立樣本T檢驗的統(tǒng)計學(xué)方法進行分析,A、B兩組病例治療前的上述指標相比,P0.05,差異無統(tǒng)計學(xué)意義。2、對A、B兩組病例治療后的Marshall評分、血尿素氮、電解質(zhì)水平、血肌酐、二氧化碳結(jié)合力、N末端前腦利鈉肽、ICU住院天數(shù)采用獨立樣本T檢驗的統(tǒng)計學(xué)方法進行分析,A、B兩組病例治療后的上述指標相比,P0.01,差異有統(tǒng)計學(xué)意義。3、對A組病例治療前后的Marshall評分、血尿素氮、電解質(zhì)水平、血肌酐、二氧化碳結(jié)合力、N末端前腦利鈉肽采用配對樣本T檢驗的統(tǒng)計學(xué)方法進行分析,A組病例治療前后的上述指標相比,P0.01,差異有統(tǒng)計學(xué)意義。4、接受連續(xù)性血液凈化治療的MODS患者中治愈出院43例(71.7%),死亡17例(28.3%);未接受連續(xù)性血液凈化治療的MODS患者中治愈出院19例(31.7%),死亡41例(68.3%),對A、B兩組患者治療后轉(zhuǎn)歸情況采取X2檢驗,P0.01,差異有統(tǒng)計學(xué)意義。5、A組病例CBP治療總時間在22~90小時之間,平均CBP治療時間為43.82±16.10小時。結(jié)論1、在臨床常規(guī)治療的基礎(chǔ)上,早期應(yīng)用連續(xù)性血液凈化治療,能有效改善多器官功能障礙綜合征患者的病情,有利于預(yù)后。2、連續(xù)性血液凈化治療是治療多器官功能障礙綜合征的有效手段,對改善患者的病情,降低患者的病死率,加速患者的康復(fù),有重要意義,有重要的臨床應(yīng)用及推廣價值。
[Abstract]:Background continuous blood purification CBP) removes some pathogenic substances from the body of the patient by means of diffusion, convection and adsorption, so that the treatment of disease .CBP is in accordance with physiological state, and can constantly adjust the liquid balance according to the need, through adsorption, convection mechanism, etc. The clearance rate of inflammatory mediators and solutes in the blood is higher [1-2], which has a remarkable curative effect in the treatment of multiple organ dysfunction syndrome (MODS). Objective to analyze retrospectively the indexes of MODS patients who received continuous blood purification therapy on the basis of clinical routine therapy and MODS patients who received only routine clinical treatment before and after treatment. To investigate the effect of continuous blood purification in patients with multiple organ dysfunction syndrome. Methods from January 2014 to September 2016, 60 patients with MODS received continuous blood purification therapy in Nanyang Central Hospital from January 2014 to September 2016. From January 2014 to September 2016, 60 patients with MODS were divided into two groups (group B) who received only routine clinical treatment without continuous blood purification therapy. The Marshall scores of the two groups were observed before and after treatment. Blood urea nitrogen bun, electrolyte level, creatinine, carbon dioxide binding capacity (CO2CPN), N-terminal forebrain natriuretic peptide (NT-proBNPN), success rate of treatment and hospitalization days of ICU were evaluated. Results 1. The Marshall score, blood urea nitrogen, electrolyte level, serum creatinine and serum creatinine were measured in group A and B before treatment. The comparison of N-terminal forebrain natriuretic peptide with carbon dioxide binding power was analyzed by independent sample T test. The above indexes in two groups were compared with that before treatment (P 0.05). There was no significant difference between the two groups (P 0.05). The Marshall scores of two groups were evaluated after treatment. Blood urea nitrogen, electrolyte level, blood creatinine, The Inpatient days of N-terminal forebrain natriuretic Peptide in ICU with carbon dioxide binding Power and N-terminal brain natriuretic Peptide in ICU were analyzed by independent sample T test. The above indexes of two groups were compared with that of P0.01 after treatment, and the difference was statistically significant. 3. The treatment of group A cases was done. Marshall scores before and after treatment, Blood urea nitrogen, electrolyte level, blood creatinine, The N-terminal forebrain natriuretic peptide of carbon dioxide binding force was analyzed by paired sample T test. The above indexes before and after treatment in group A were compared with that in group A (P 0.01), the difference was statistically significant. 4. The patients received continuous blood purification therapy. 43 cases of MODS were cured and discharged 43 cases were cured, 17 cases died, 19 cases were cured and discharged from MODS patients without continuous blood purification therapy, 41 cases died 68.3%. X2 test P0.01 was used to evaluate the prognosis of two groups of patients with MODS, the difference was statistically significant. The total time of CBP treatment in group A was between 22 and 90 hours. The average CBP treatment time was 43.82 鹵16.10 hours. Conclusion 1. On the basis of routine clinical treatment, early application of continuous blood purification therapy can effectively improve the condition of patients with multiple organ dysfunction syndrome. Continuous blood purification therapy is an effective method for the treatment of multiple organ dysfunction syndrome. It is of great significance to improve the patient's condition, reduce the mortality rate of the patient, and accelerate the recovery of the patient. It has important clinical application and promotion value.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R459.7

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