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目的在创伤后糖代谢障碍多脏器功能障碍综合征(MODS)患者中,探索及评估连续性静脉-静脉血液滤过(CVVH)的理想置换液配方,并与改良的Port配方作比较,评价其效果和预后。方法回顾性分析2001年1月至2006年12月在第四军医大学第一附属医院接受CVVH治疗的134例创伤后糖代谢障碍MODS患者,按置换液分为两组:葡萄糖浓度为59.1 mmol/L的改良Port配方组(A组,n=59)和葡萄糖浓度为11.8 mmol/L的自配方组(B组,n=75)。观察治疗期间电解质、血气分析、血糖和渗透压的变化。结果①A组的病死率明显高于B组(64.4%vs 40.0%,P=0.005);②治疗前,两组的APACHEⅡ评分差异无统计学意义,但是在存活者及死亡者中B组APACHEⅡ评分均高于A组(P<0.05)。③CVVH治疗12 h后,B组的血糖浓度和渗透压分别为(11.2±1.9)mmol/L和(316.1±8.9)mOsm/L,更接近生理状况,明显低于A组的(16.8±3.2) mmol/L和(332.3±9.6)mOsm/L,(P<0.05)。④在B组单个置换液循环中,置换液平均有(65%±3%)的葡萄糖经废液流失。结论自配方置换液在血糖和渗透压调控方面优于改良Port配方,可降低病死率。
Objective To explore and evaluate the ideal replacement fluid formulation of continuous veno-venous hemofiltration (CVVH) in patients with post-traumatic glucose metabolism disorders with multiple organ dysfunction syndrome (MODS) and to compare with the modified Port formulation Its effect and prognosis. Methods A retrospective analysis of 134 post traumatic post-traumatic glucose metabolism disorders MODS patients who received CVVH at the First Affiliated Hospital of the Fourth Military Medical University from January 2001 to December 2006 were divided into two groups according to replacement fluid: glucose at a concentration of 59.1 mmol / L modified Port formulation group (group A, n = 59) and self-formulated group (group B, n = 75) with a glucose concentration of 11.8 mmol / L. Electrolytes, blood gas analysis, changes in blood glucose and osmotic pressure were observed during treatment. Results ① The mortality in group A was significantly higher than that in group B (64.4% vs 40.0%, P = 0.005). ② Before treatment, there was no significant difference in APACHEⅡscore between the two groups, but in survivors and deaths, APACHEⅡscore All higher than A group (P <0.05). ③ After 12 hours of CVVH treatment, the blood glucose level and osmotic pressure in group B were (11.2 ± 1.9) mmol / L and (316.1 ± 8.9) mOsm / L, respectively, which were more similar to those in group A (16.8 ± 3.2) mmol / L and (332.3 ± 9.6) mOsm / L, respectively (P <0.05). ④ in a single replacement liquid B group cycle, the average replacement fluid (65% ± 3%) of the loss of glucose waste. Conclusion Self-formula replacement fluid is superior to Modified Port formula in the regulation of blood glucose and osmotic pressure, which can reduce the mortality.