脉冲式高容量血液滤过用于严重脓毒症的观察  

The Research of Different Pulse High Volume Haemofiltration Projects in Severe Sepsis Patients

作　　者：卜会驹[1] 郭发良[1] 杭寒皎[1] 王存[1] 苏晓燕[1] 林小茂[1] 秦志梅[1] 

机构地区：[1]中山大学附属东华医院,广东东莞523110

出　　处：《现代临床医学》2013年第1期5-7,10,共4页Journal of Modern Clinical Medicine

基　　金：广东省东莞市科技局2010年立项课题;项目编号201010515000174

摘　　要：目的:探讨不同的脉冲式高容量血液滤过方案在严重脓毒症患者中的应用价值。方法:将严重脓毒症患者66例,按照随机原则分为:A组21例(脉冲式高容量血液滤过组8-16方案),B组20例(脉冲式高容量血液滤过组,4-8、4-8方案),C组25例(持续高容量血液滤过组)进行不同方法的血液滤过治疗,记录开始和72 h后APACHEⅢ评分、生化指标、炎症指标的变化。记录每组患者的滤器平均使用时间、置换液使用总量、肝素使用总量、28天病死率等数据,进行比较分析。结果:治疗72 h后,3组患者炎症因子、肌酐均有明显下降,组间无显著性差异。24 h乳酸清除率无显著性差异(P>0.05)。红细胞用量B组<A组<C组,血小板数量B组>A组>C组(P<0.05)。血滤液体总量A组、B组间无差异,都明显小于C组;滤器平均使用时间B组>A组>C组(P<0.05)。3组患者肝素用量、72 h后的APACHEⅢ评分、28天病死率无显著性差异(P>0.05)。结论:在严重脓毒症患者中,脉冲式高容量血液滤过与持续高容量血液滤过的效果相同,但相对可以节约液体用量与耗材用量,减少对血液、凝血系统的影响,其中4-8、4-8方案较8-16方案的优点更为突出。Objective：To research the advantages of different pulse high volume haemofiltration projects in Severe sepsis patients. Methods ：66 Severe sepsis patients were divided randomly into 3 groups： group A ,20 patients（pulse high volume haemofiltration group with 8 -16 project） ;group B,21 patients（group with 4 -8, 4- 8 project） ; group C, 25 paitents （high volume haemofiltration group）. The patients undergoed different haemofihration methods. The APACHEⅢ scores, changes of biochemistry, inflammation index were recorded when beginning and after 72 hours. And filter life time, usage amount of displacement liquid and heparin, 28 days mortality of these groups were recorded. All datas were compared and analyzed. Results：After 72 hours treatment, inflammation index and creatinine levels of these groups were decreased similarly. 24 hours lactic acid clean rates were no different too （ P 〉 0.05 ）. Usage of red blood cell in group B 〈 group A 〈 group C, quantity of platelet in group B 〉 group A 〉 group C. Amount of displacement liquid of group A and B were smaller than group C obviously. Filter life time in group B 〉 group A 〉 group C （ P 〈 0.05 ）. Usage amount heparin, APACHEⅢ scores after 72 hours,28 days mortality of these groups were similar. Conclusions：Pulse high volume haemofiltration in Severe sepsis patients are effects and similar to continuious high volume haemofiltration, that save liquids and materials , reduce influences to blood and thromboxane system at the same time, and 4 - 8,4 - 8 project have more advantages than 8 - 16 project.

关 键 词：脉冲式 高容量 血液滤过 严重脓毒症 

分 类 号：R631.2[医药卫生—外科学]