连续性肾脏替代疗法治疗感染性休克的效果观察  

Study of continuous renal replacement therapy in patients with septic shock

作　　者：黄桔秀[1] 朱慧民[2] 金礼通[1] 

机构地区：[1]浙江省台州市中心医院急诊科,318000 [2]浙江省台州市中心医院老年科

出　　处：《中国急救复苏与灾害医学杂志》2012年第4期321-325,共5页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的观察连续性肾脏替代疗法（ContinuousRenalReplacementTherapy，CRRT）的连续性静脉一静脉血液滤过（CVVH）方法对感染性休克患者临床疗效，并探讨其机制，旨在为感染性休克的连续性肾脏替代治疗提供理论依据。方法选择收ICU住院治疗的感染性休克患者60例，随机分为CRRT治疗组（治疗组）与常规治疗组（对照组），比较两组患者在开始治疗（Oh）和治疗后24h、48h、72h等4个时点的血流动力学指标，血生化指标，氧合指数，患者使用血管活性药物的情况、APACHEII评分的变化。结果治疗前，治疗组与对照组的病情及一般临床资料比较无明显差别。治疗后CRRT组患者的血流动力学及肾功能等各项指标的恢复及APACHEII评分的改善明显快于常规治疗组（P〈O．05），在治疗48h、72h时尤为明显（P〈0．01）。在治疗72h时，治疗组停用血管活性药物例数多于对照组（P〈0．05）。结论连续性肾脏替代疗法（CRRT）能明显改善感染性休克患者的组织灌注，纠正酸中毒，改善氧合，稳定血压，减少升压药的用量。连续性肾脏替代疗法（CRRT）是治疗感染性休克的有效手段。Objective To observe efficiency of continuous veno - venous Hemofiltration （CVVH） in patients with septic shock and explore its mechanism so as to provide theoretic basis for continued renal replacement therapy （CRRT） on patients with septic shock. Methods Sixty patients with septic shock were selected from the ICU and randomly divided into treatment group of CRRT （30 patients） and control group （30 patients）. A comparison was made between the two groups in HR, MAP, Pao2, OI （Pao2 · Fio2-1）, lactic acid, Creatinine, Urea nitrogen of blood, APACHEII score, Isotropic drug dosage at four different times after the treatment was given - 0 hour, 24 hours, 48 hours and 72 hours respectively. Results HR, MAP, Pao2, OI （Pao2 · Fio2-1）, lactic acid, Creatinine, Urea nitrogen of blood, APACHEII score of the CRRT group improved more than those of the control group （P〈0.05）. 72 hours after the treatment, eight patients in the CRRT group discontinued Inotropic while two patients in the control group did with a significant difference （P〈0.05）. Conclusion CRRT combined with conventional therapy may improve the treatment to septic shock with tissue perfusion improvement, acidosis correction, oxygenation improvement and stabilize blood pressure and reduce isotropic drugs usage. CRRT is considered an effective treatment method for septic shock.

关 键 词：连续性肾脏替代疗法 感染性休克 APACHEⅡ评分 氧合指数 

分 类 号：R631.4[医药卫生—外科学]