[The effect of continuous hemofiltration in the treatment of traumatic patients with refractory acute cephalocele after craniotomy]

To investigate the effect and the possible mechanism of continuous hemofiltration in the treatment of traumatic patients with refractory acute cephalocele.Continuous venous-venous hemofiltration (CVVH) was applied to 9 traumatic patients with refractory acute cephalocele after craniotomy. The changes in patients' physical signs, electrolytes, blood gas analysis, biochemical and blood clotting indexes as well as the outcome were observed.(1) The later the CVVH started, the worse the disorders became such as unstable body temperature, respiratory rate, heart rate, blood pressure and abnormal blood gas analysis. The most significant abnormality emerged with a delay of 12 hours. The above abnormalities returned to normal and kept stable within 12 hours of CVVH. CVVH maintained body temperature in hypothermic state, and serum lactic acid was kept at a low level without disturbance of blood coagulation function. (2) The duration between occurrence of cephalocele and beginning of CVVH was 2-16 hours, with a mean of (5.4±5.1) hours, the duration of CVVH was 23-129 hours, with a mean of (75.7±34.3) hours, and the net volume of liquid balance (NVLB) was -1.2-3.1 L, with a mean of (0.76±1.46) L. Height of encephalocele over skull window (HEOSW) was 51.8±10.0 mm and 51.0±10.0 mm before and 72 hours after CVVH. NVLB and HEOSW did not show obvious correlation with the prognosis of the patients. (3) Four patients survived, and 2 patients showed satisfactory outcome with Glasgow outcome scale (GOS) over 12 after follow-up for 3 months, and 2 patients showed improvement with GOS of 8 but in vegetative state 3 months later. Five patients died of respiratory failure and multiple organ dysfunction syndrome (MODS) 9-35 days after the termination of CVVH.CVVH was safe and effective in certain extent in the treatment of refractory acute cephalocele. The direct causes of death of the patients were complications instead of the cephalocele itself. The outcomes of the patients were related to the time of beginning of CVVH and the duration of CVVH, and there was nothing to do with the NVLB and the HEOSW. The study implicated that the effect of CVVH on these patients was not brain-dehydration solely. It also exerted certain effect on regulating water-electrolyte balance, acid-base balance and body temperature.