集束化联合高容量血液滤过治疗感染性休克的临床研究  

Clinical study of the treatment on patients suffering from septic shock with the combination of high-volume hemofiltration(HVHF) and sepsis bundles

作　　者：卢年芳[1] 郑瑞强[1] 林华[1] 邵俊[1] 於江泉[1] 

机构地区：[1]江苏省苏北人民医院扬州大学临床医学院ICU,江苏扬州225001

出　　处：《中华医院感染学杂志》2013年第23期5692-5694,共3页Chinese Journal of Nosocomiology

基　　金：江苏省"333高层次人才培养工程"基金资助(2011-3)

摘　　要：目的探讨高容量血液滤过(HVHF)联合集束化治疗,对感染性休克并多器官功能障碍综合征(MODS)患者治疗效果。方法分析2009年1月-2011年12月51例感染性休克患者临床资料,随机分为集束化治疗组26例和集束化治疗联合高容量血液滤过(HVHF)组25例,观察两组患者治疗前后急性生理学及慢性健康状况评价Ⅱ(APACHEⅡ)评分,序贯性器官衰竭(SOFA)评分,治疗前后血浆白介素-6(IL-6)、IL-10、降钙素原(PCT)水平、动脉血乳酸及乳酸清除率。结果两组患者治疗后APACHEⅡ评分、SOFA评分均逐渐降低,且治疗72h时HVHF联合集束化治疗组显著低于集束化治疗组(P<0.05);两组治疗后血清IL-6、IL-10、PCT水平均逐渐降低,HVHF联合集束化治疗组72h时显著低于集束化治疗组(P<0.05);两组治疗后动脉血乳酸清除率均逐渐升高;集束化治疗联合HVHF组治疗后6、12、24h动脉血乳酸清除率(15.1±8.3)%、(23.6±7.4)%、(27.3±9.2)%明显高于集束化治疗组(10.8±7.5)%、(12.5±8.4)%、(17.4±10.4)%。结论 HVHF联合集束化治疗能降低感染性休克患者APACHEⅡ评分、SOFA评分、PCT、炎症介质和动脉血乳酸水平,改善患者的预后。OBJECTIVE To explore the efficacy of combination treatment of high-volume hemofiltration （HVHF） and sepsis bundles on patients with septic shock and multiple organ dysfunction syndrome （MODS）. METHODS A total of 51 patients suffering from septic shock in our hospital from Jan. 2009 to Dec. 2011 were randomly divided into two groups for analysis, sepsis bundles group （n= 26） and the combination group of HVHF and sepsis bun-dles （n=25）. The acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score, sequential organ fail-ure assessment （SOFA）, plasma interleukin-6 （IL-6）, IL-10, procalcitonin （PCT） level, arterial blood lactate and lactate clearance rate before and after treatment between two groups were observed. RESULTS After treatment, the APACHE Ⅱ and SOFA scores were gradually reduced between the two groups. The APACHE Ⅱ and SOFA in the combination group of HVHF and sepsis bundles at 72h was significantly lower than that of sepsis bundles group （P〈0.05）. The leaeel of serum IL-6, IL-10 and PCT decreased after treatment in both groups, which was significantly lower at 72h in the combination group （P〈0.05）. The arterial blood lactate clearance rate increased gradually after treatment in both groups; which was significantly higher at 6, 12, 24 h （15. 1±8. 3）%, （23.6 ±7.4）%, （27.3±9.2）% in the combination group than that of sepsis bundles group （10.8±7.5）%, （12.5 ±8.4）%, （17.4±10.4）%. CONCLUSION The combination treatment of HVHF and sepsis bundles can reduce APACHE Ⅱ score, SOFA score, PCT, mediators of inflammation and arterial blood lactate levels in patients with septic shock, and improve the patient outcomes.

关 键 词：集束化 高容量血液滤过 感染性休克 

分 类 号：R181.32[医药卫生—流行病学]