连续性静脉-静脉血液滤过联合血液灌流治疗严重脓毒症临床研究

发布时间：2018-04-06 03:36

本文选题：连续性静脉-静脉血液滤过　切入点：血液灌流　出处：《中国实用内科杂志》2016年01期

【摘要】：目的探讨连续性静脉-静脉血液滤过(CVVH)联合血液灌流(HP)应用于严重脓毒症的临床意义。方法入选2011年12月至2014年8月收治梅州市人民医院重症医学一科的92例严重脓毒症存在血液净化治疗指征患者,随机分为CVVH组及CVVH+HP组,比较两组治疗过程中炎症介质C-反应蛋白(CRP)、补体3(C3)、内毒素;血流动力学指标平均动脉压(MAP)、中心静脉压(CVP);组织器官灌注指标血乳酸(Lac)、中心静脉血氧饱和度(Scv O2)、氧合指数(Pa O2/Fi O2);以及血小板、感染相关器官功能衰竭评分(SOFA)。结果 CVVH+HP组治疗72 h时CRP、C3及内毒素降至最低,且低于CVVH组;治疗12 h后CVVH+HP组Lac低于CVVH组(P0.05),Scv O2高于CVVH组(P0.05);MAP、CVP两组间差异无统计学意义(均P0.05);治疗24h CVVH+HP组Pa O2/Fi O2较CVVH组升高(P0.05),治疗12 h后,CVVH+HP组患者血小板水平较治疗前有所下降,且较CVVH组更低(均P0.05),治疗48h SOFA评分亦较CVVH组降低(P0.05)。结论 CVVH联合HP能够有效清除炎症介质,提高严重脓毒症患者氧合状态,改善组织器官灌注,改善器官功能,但对血小板有一定破坏。
[Abstract]:Objective to investigate the clinical significance of continuous veno-venous hemofiltration (CVVH) combined with hemoperfusion (HPV) in severe sepsis.Methods from December 2011 to August 2014, 92 patients with severe sepsis who were admitted to the Department of intensive Medicine of Meizhou people's Hospital were randomly divided into CVVH group and CVVH HP group.The inflammatory mediators, C- reactive protein (CRP), complement 3 (C 3) and endotoxin, were compared between the two groups during the course of treatment.Mean arterial blood pressure (map), central venous pressure (CVP), blood lactate (lactic acid), central venous oxygen saturation (scvO _ 2), oxygenation index (Pa O2/Fi O _ 2), and platelet, infection related organ failure score were evaluated.Results the levels of C 3 and endotoxin in CVVH HP group decreased to the lowest at 72 h after treatment, and were lower than those in CVVH group.After 12 hours of treatment, the Lac of CVVH HP group was lower than that of CVVH group (P 0.05%), and that of CVVH group was higher than that of CVVH group (P 0.05), and that of 24 h CVVH HP group was higher than that of CVVH group (P 0.05), and the platelet level of CVVH HP group was lower than that of CVVH group at 12 h after treatment.It was lower than that in CVVH group (all P 0.05), and the SOFA score at 48 h after treatment was lower than that in CVVH group (P 0.05).Conclusion CVVH combined with HP can effectively remove inflammatory mediators, improve oxygenation state, improve tissue and organ perfusion, and improve organ function in patients with severe sepsis.
【作者单位】：广东省梅州市人民医院重症医学一科;
【基金】：广东省科技计划项目(20110311)
【分类号】：R459.7

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