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目的观察低温高容量血液滤过对重型颅脑损伤患者血清脑钠肽含量的影响。方法选择重型颅脑损伤患者68例格拉斯哥昏迷量表(GCS)评分8分,按随机数字表法分为对照组(A组34例)和低温高容量血液滤过组(B组34例)。对照组采用常规治疗,低温高容量血液滤过组在常规治疗的基础上加低温高容量血液滤过治疗7d。置换液为3.0~4.0L/h,血流量为180~200ml/min;两组患者均于治疗后第1、3、5和7d采用酶联免疫吸附试验法测定血清抗脑抗体含量,并进行格拉斯哥昏迷量表(GCS)评分。结果低温高容量血液滤过组治疗后第3d起,血清抗脑抗体浓度显著低于对照组〔第3d:(1.63±0.35)k U/L比(2.17±0.30)k U/L;第5d:(1.45±0.17)k U/L比(1.97±0.22)k U/L;第7d:(1.01±0.37)k U比(1.89±0.35)k U(P<0.05或<0.01)〕。低温高容量血液滤过组治疗后第7d起,GCS评分显著高于对照组〔第7d:(9.95±1.13)分比(4.74±1.41)分;(P<0.01)〕。结论低温高容量血液滤过能够降低重型颅脑损伤患者血清抗脑抗体含量,改善预后。
Objective To observe the effect of low temperature and high volume hemofiltration on serum brain natriuretic peptide in patients with severe craniocerebral injury. Methods Sixty patients with severe craniocerebral injury were divided into control group (34 cases in group A) and low-temperature high-capacity hemofiltration group (group B, 34 cases) with Glasgow Coma Scale (GCS) score of 8 points. The control group was treated by conventional therapy. The hypothermic high-volume hemofiltration group was treated with hypothermia and high-volume hemofiltration for 7 days on the basis of routine treatment. The volume of replacement fluid was 3.0-4.0 L / h and the blood flow was 180-200 ml / min. Serum anti-brain antibody levels were measured by enzyme-linked immunosorbent assay at 1, 3, 5 and 7 days after treatment in both groups Glasgow coma scale (GCS) score. Results The concentration of anti-brain antibody in serum was significantly lower than that of the control group at 3d (1.63 ± 0.35) kU / L (2.17 ± 0.30) kU / L on the 3rd day after treatment in the low-temperature and high-volume hemofiltration group. (1.45 ± 0.17) k U / L ratio (1.97 ± 0.22) k U / L; and on the 7th day: (1.01 ± 0.37) k U ratio (1.89 ± 0.35) k U (P <0.05 or <0.01). GCS score was significantly higher than that of the control group on the 7th day after treatment in the low-temperature and high-volume hemofiltration group [7d: (9.95 ± 1.13) vs 4.74 ± 1.41 (P <0.01)]. Conclusion Low temperature and high volume hemofiltration can reduce serum anti-brain antibody in patients with severe craniocerebral injury and improve prognosis.