【摘要】：多器官功能障礙綜合征(MODS)是ICU患者死亡的主要原因之一,目前仍是危重癥醫(yī)學(xué)專(zhuān)業(yè)研究的重點(diǎn)和難點(diǎn),在近些年的研究和臨床實(shí)踐中,血液凈化技術(shù)為多器官功能不全的治療提供了新的思路和方法,本文回顧性的報(bào)道和分析了我科收治的四份病歷,它們分別因爆發(fā)性心肌炎、HIV感染為基礎(chǔ)疾病繼發(fā)感染、重癥急性胰腺炎、中毒可能的疾病發(fā)展為MODS的患者,在病情發(fā)展過(guò)程中出現(xiàn)了兩個(gè)或兩個(gè)以上器官功能的受損或不全,尤其以肝、腎功能不全為突出表現(xiàn)即丙氨酰氨基轉(zhuǎn)移酶(ALT)、天門(mén)冬氨酸氨基轉(zhuǎn)移酶(AST)、總膽紅素(TB)、尿素(Urea)和肌酐(Cre)等生化指標(biāo)異常升高,我們給予CWH血液凈化的基礎(chǔ)上,根據(jù)病人情況分別聯(lián)合了血漿置換或膽紅素吸附治療,雖然患者的最終死亡率無(wú)明顯改善,但這四例患者在綜合治療中采用組合式血液凈化技術(shù)后患者相應(yīng)器官的生化指標(biāo)基本恢復(fù)正常,同時(shí)病情得到明顯的改善,其中三例患者最終死于原發(fā)病。結(jié)論：組合式血液凈化能有效改善多器官功能障礙情況,但如果原發(fā)病情況不能得到有效控制,那么死亡率仍然不能得到有效改善。
[Abstract]:Multiple organ dysfunction syndrome (MODS) is one of the leading causes of death in ICU patients. Blood purification technology provides a new way of thinking and method for the treatment of multiple organ dysfunction. This paper reviews and analyzes four medical records in our department. They are secondary infections due to outbreak myocarditis and HIV infection, respectively. In patients with severe acute pancreatitis, a potentially toxic disease that develops into MODS, two or more organ functions are impaired or incomplete, especially in the liver. Renal insufficiency was characterized by abnormal elevation of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), urea (Urea) and creatinine (Cre). On the basis of CWH blood purification, we combined plasma exchange or bilirubin adsorption therapy according to the patient's condition, although there was no significant improvement in the final mortality of the patient. But after the combined blood purification technique was used in the four patients, the biochemical indexes of the corresponding organs were basically restored to normal, and the condition of the patients was obviously improved. Three of the patients died of the primary disease. Conclusion: combined blood purification can effectively improve the condition of multiple organ dysfunction, but if the primary disease can not be effectively controlled, then the mortality can not be effectively improved.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R459.7

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本文編號(hào)：2429487