连续性静脉-静脉血液滤过联合血液灌流治疗严重脓毒症临床研究  

Clinical effect of continuous veno-venous hemofiltration combined with hemoperfusion in the treatment of patients with severe sepsis

作　　者：张彦峰[1] 罗伟雄[1] 罗伟文[1] 

机构地区：[1]广东省梅州市人民医院重症医学一科,广东梅州514031

出　　处：《中国实用内科杂志》2016年第1期57-59,共3页Chinese Journal of Practical Internal Medicine

基　　金：广东省科技计划项目(20110311)

摘　　要：目的探讨连续性静脉-静脉血液滤过(CVVH)联合血液灌流(HP)应用于严重脓毒症的临床意义。方法入选2011年12月至2014年8月收治梅州市人民医院重症医学一科的92例严重脓毒症存在血液净化治疗指征患者,随机分为CVVH组及CVVH+HP组,比较两组治疗过程中炎症介质C-反应蛋白(CRP)、补体3(C3)、内毒素;血流动力学指标平均动脉压(MAP)、中心静脉压(CVP);组织器官灌注指标血乳酸(Lac)、中心静脉血氧饱和度(Scv O2)、氧合指数(Pa O2/Fi O2);以及血小板、感染相关器官功能衰竭评分(SOFA)。结果 CVVH+HP组治疗72 h时CRP、C3及内毒素降至最低,且低于CVVH组;治疗12 h后CVVH+HP组Lac低于CVVH组(P<0.05),Scv O2高于CVVH组(P<0.05);MAP、CVP两组间差异无统计学意义(均P>0.05);治疗24h CVVH+HP组Pa O2/Fi O2较CVVH组升高(P<0.05),治疗12 h后,CVVH+HP组患者血小板水平较治疗前有所下降,且较CVVH组更低(均P<0.05),治疗48h SOFA评分亦较CVVH组降低(P<0.05)。结论 CVVH联合HP能够有效清除炎症介质,提高严重脓毒症患者氧合状态,改善组织器官灌注,改善器官功能,但对血小板有一定破坏。Objective To evaluate the clinical effect of continuous veno-venous hemofiltration （CVVH）combined with hemoperfusion （HP） in treating patients with severe sepsis. Methods Ninety-two patients with severe sepsis from December 2011 to August 2014 were enrolled in this study, and were randomly divided into CVVH group and CVVH＋HP group. C-reactive protein（CRP）, complement 3（C3）, endotoxin（ETX）, mean arterial pressure（MAP）, central venous pressure （CVP）, lactic acid（Lac）, central venous oxygen saturation（ScvO2）, oxygenation index （PaO2/FiO2）, and platelet and sepsis--related organ failure assessment （SOFA） were compared between two groups. Results After CVVH combined with HP was conducted for 72 hours, the serum levels of CRP, C3 and ETX were significantly reduced. After CVVH combined with HP was carried for 12 hours Lac was obviously reduced（ P〈 0.05）, while ScvO2 was markedly increased（ P 〈 0.05） compared to group CVVH. In two groups MAP and CVP were not changed （P〉 0.05）. PaO2/FiO2 of patients in group CVVH＋HP improved compared to group CVVH after 24 hours （P〈0.05）. The platelets of patients in CVVH＋HP group decreased after 12 hours compared to pretherapy and CVVH group. SOFA scores were significantly reduced compared to group CVVH after 48 hours. Conclusion CVVH combined with HP can effectively eliminate the inflammatory mediators, improve oxygenation and organ perfusion and eventually promote organ function, but partly destroy the platelets.

关 键 词：连续性静脉-静脉血液滤过 血液灌流 严重脓毒症 

分 类 号：R512.62[医药卫生—内科学]