连续性血液净化救治突发公共卫生事件致急危重症患者的临床研究

摘要

探讨连续性血液净化(CBP)救治时机对突发公共卫生事件致急危重症患者预后的影响.研究济南军区血液净化治疗中心采用CBP紧急救援89例突发公共卫生事件致危重病的临床资料,并根据患者接受CBP治疗距发病后的自然时间为“截点”,将患者分为:(1)A组(早期治疗)43例,于急性损伤期(发病≤24h)开始CBP治疗.(2)B组(晚期治疗)46例,即在多器官功能损伤期(发病＞24h)开始CBP治疗,分析CBP治疗时机及各种创伤因素对预后的影响.(1)6起89例突发公共卫生事件致危重病包括:急性中毒31例、挤压综合症7例、热射病27例、烧伤16例、感染5例和三聚氰胺污染事件3例.经CBP治疗后患者生命特征、急性生理学及慢性健康状况Ⅱ( APACHEⅡ)评分值明显改善,总存活率为78.65％(70/89),病死率为21.35％(19/89),其中A组痊愈率显著高于B组(86.05％vs 60.87％,P＜0.05)；病死率则明显低于B组(13.95％ vs28.26％,P＜0.05).(2)在各类损伤中,烧伤与传染病病死率最高,其次为挤压综合症、急性中毒和热射病,主要致死原因是并发脓毒症及多器官功能障碍综合征(MODS).CBP不仅是一种技术措施,更是一种治疗思维模式,即强调稳定性、均衡性、持续性地平衡免疫内稳态、改善器官或细胞生存内环境,及早实施可使病变终止于损伤期,避免其诱发全身炎症反应综合症(SIRS)、弥漫性血管内凝血(DIC)和MODS,降低病死率,是抢救突发公共卫生事件致危重病的有效方法.%To investigate the contribution of continuous blood purification (CBP) remedy occasion choice to the prognosis of emergency and severe cases in sudden public health events. To study about the clinical data of hemodialysis center in general hospital, which application CBP to 89 emergency and severe cases Furthermore, with natural time which adopted CBP therapy after ictus as the "assessment cut-off point", to analyze the contribution of CBP remedy occasion choice and various of trauma factors to the prognosis. All the patients were divided into 2 groups :43 with CBP therapy since the acute injury period (ictus≤24h) as group A (early treatment) ,46 with CBP therapy since multi- organ function injury period(ictus>24h) as group B (advanced stage treatment) .Results show that (1)89 emergency and severe cases included 31 acute poisoning,7 extrusion syndrome,27 heat stroke, 16 bums,5 infection and 3 melamine events. After CBP therapy, vital signs and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) score of the patients were improved obviously,the total survival rate was 78.65% (70/89),fatality rate was 21.35% (19/89),and the recovery rate in group A was significantly higher than that of group B (86.05% vs 60.87% P< 0.05), however, the fatality rate in group A was significantly lower than that of group B (13.95% vs 28.26 %, P < 0.05). (2) Fatality rate of burns and communicable diseases were the top in various kinds of injury, the extrusion syndrome, acute poisoning and heat stroke were next to it.Mean factors which causing death were sepsis and multiple organ dysfunction syndrome (MODS) complicated by it.CBP is not only a technique, but also a thinking mode of treatment which emphasizes the balance of the immune homeostasis, improve the internal environment of organ or cell viability with stability, equilibrium and continuity. Early implementation can make lesions terminated in injury period, avoid systemic inflammatory response syndrome (SIRS), disseminate intravascular coagulation (DIC) and MODS to be evoked and decrease the fatality rate. It is an utility way to rescue the emergency and severe cases caused in sudden public health events.