高容量血液滤过对老年脓毒症血流动力学和氧代谢的影响  

Effect of High Volume Hemofiltration on Hemodynamics and Oxygen Metabolism in Elderly Patients with Sepsis

作　　者：赵黎[1] 张任[1] 曾艳[1] 阮华玲[1] 

机构地区：[1]湖北医药学院附属东风医院肾内科,湖北省十堰市442008

出　　处：《中华全科医学》2013年第2期200-201,共2页Chinese Journal of General Practice

摘　　要：目的探讨高容量血液滤过(HVHF)对老年脓毒症血流动力学和氧代谢的影响。方法 85例老年脓毒症患者,每日行HVHF治疗12～18 h,观察HVHF治疗前(0 h)和治疗(24、48、72 h)后患者心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心排血量(CO)、外周循环阻力(SVR)、肺循环阻力(PVR)、平均肺动脉压(MPAP)、肺动脉楔压(PAWP)、血氧合指数(PaO2/FiO2)、氧输送(DO2)、氧消耗(VO2)、氧摄取率(O2ER)、急性生理与慢性健康评分Ⅱ(A-PACHEⅡ)、序贯器官衰竭评估(SOFA)的变化。结果 HVHF治疗72 h内,存活65例,存活率76.5%。HVHF治疗48～72 h后患者的HR、MAP、CVP、CO、SVR、PVR、MPAP、PaO2/FiO2、DO2、VO2、O2ER,APACHEⅡ和SOFA评分与治疗前差异均有统计学意义(P<0.05)。结论 HVHF可以提高老年脓毒症患者的存活率,改善老年脓毒症的血流动力学和氧代谢,降低患者的APACHEⅡ和SOFA评分。Objective To investigate the effect of continuous high volume hemofiltration（HVHF） on the hemodynamics and oxygen metabolism in elderly patients with sepsis. Methods Eighty-five elderly patients with sepsis received HVHF for 12 - 18 hours every day. Heart rate （HR） , mean arterial pressure （MAP） , central venous pressure （CVP） , cardiac output （ CO ） , systemic vascular resistance （ SVR）, pulmonary vascular resistance （ PVR ）, mean pulmonary arterial pressure （ MPAP ）, pulmonary artery wedge pressure （PAWP）, oxygenation index（ PaO2/FiO2 ）, oxygen delivery （DO2 ）, oxygen consumption （VO2 ）, oxygen extraction rate （02 ER） , acute physiology and chronic health evaluation l] （APACHE Ⅱ ） , sequential organ failure assessment （SOFA） were observed before and after the treatment at 24,48,72 hours. Results All 65 cases survived and the mortality rate was 76.5%. HR, MAP, CVP, CO, SVR, PVR, MPAP, PaOE/FiO2, DO2, VO2,02 ER, APACHE Ⅱ and SOFA were improved significantly after 48 to 72 hours of HVHF in patients （ P 〈 0.05 ）. Conclusion HVHF can improve the mortality rate and can improve hemody-namics and oxygen metabolism and lowers the scores of APACHE Ⅱ and SOFA in elderly patients with sepsis.

关 键 词：高容量血液滤过 老年人 脓毒症 血流动力学和氧代谢 

分 类 号：R459.53[医药卫生—治疗学] R631[医药卫生—临床医学]