高容量血液滤过对老年严重脓毒症患者肠屏障功能的影响  

Effect of high volume hemofiltration on intestinal barrier function in patients with severe sepsis

作　　者：王玲玲[1] 郭振辉[1] 刘坚[1] 陈蕊[1] 姜巧[1] 孙杰[1] 俞宙[1] 肖飞[1] 熊日成[1] 

机构地区：[1]广州军区广州总医院MICU,广东广州510010

出　　处：《中国急救医学》2014年第10期869-872,共4页Chinese Journal of Critical Care Medicine

基　　金：全军医药卫生科研专项基金（卫保健[2010]119号-10BJZ09）;广州市科研专项基金（2014J4100033）

摘　　要：目的：探讨高容量血液滤过（ HVHF）对老年严重脓毒症患者肠屏障功能的影响。方法按随机原则将严重脓毒症患者分为常规治疗组31例，联合HVHF组23例，分别于入住ICU当时、第2天、第3天、第7天采集外周血，测定血浆肠型脂肪酸结合蛋白（ IFABP）、二胺氧化酶（ DAO）、D-乳酸，并记录28 d病死率。结果治疗前两组IFABP、DAO、D-乳酸水平比较差异无统计学意义（P＞0．05），治疗后均有所下降，除第3天两组血浆IFABP水平比较差异无统计学意义（ P＞0．05）外，其余各时间点联合HVHF组较同期常规治疗组各指标均显著下降（ P＜0.05）。联合HVHF组28 d病死率显著低于常规治疗组（39．1％ vs 80.6％， P＜0．05）。结论HVHF对老年严重脓毒症患者肠屏障功能具有保护作用，可显著降低病死率，并改善预后。Objective Tto evaluate the change in intestinal barrier function in patients with severe sepsis during HVHF therapy .Methods Fifty -four patients were randomly divided into the control group （ n =31 ） and the HVHF group （ n =23 ） .Peripheral blood from sepsis patients were routinely collected on day 0, 2, 3, 7 after admission.The levels of IFABP, DAO and D-lactate were measured, and death rate of patients in 28 days were recorded.Results There was no difference between the two groups at baseline .However , compared with the conventional treatment group , the plasma levels of IFABP , DAO and D-lactate of HVHF group after HVHF were significantly decreased except for IFABP on day 3 （P〈0.05）, and the 28-day mortality was significantly reduced （39.1%vs 80.6%, P 〈0.05）.Conclusion HVHF can protect intestinal barrier function, and reduce the mortality as well as improve clinical outcome in elderly patients with sepsis .

关 键 词：高容量血液滤过( HVHF) 严重脓毒症 肠屏障 肠型脂肪酸结合蛋白( IFABP) 二胺氧化酶( DAO) D-乳酸 

分 类 号：R459.5[医药卫生—治疗学]