早期持续高容量血液滤过联合血液灌流治疗严重脓毒症的疗效观察  

Therapeutic effect of early continuous high volume hemofiltration combined with blood perfusion on severe sepsis

作　　者：陈泽宇[1] 刘俊[1] 徐志坚[1] 刘端绘 梁振杰[1] 莫毅[1] 

机构地区：[1]广西梧州市红十字会医院重症医学科,梧州市543002

出　　处：《广西医学》2016年第12期1664-1666,共3页Guangxi Medical Journal

基　　金：广西梧州市科学研究与技术开发计划(201302004)

摘　　要：目的探讨早期持续高容量血液滤过联合血液灌流治疗严重脓毒症疗效。方法严重脓毒症患者80例,随机分为观察组与对照组各40例,均给予抗感染集束化治疗,观察组确诊脓毒症后立即给予持续高容量血液滤过联合血液灌流治疗。于治疗前、治疗72 h后测定急性生理和慢性健康状态评分Ⅱ(APACHEⅡ)、平均动脉压、血白细胞(WBC)、谷丙转氨酶(ALT)、血肌酐(SCr)、C反应蛋白(CRP)、白介素6(IL-6)、血乳酸水平;计算28 d生存率,记录心血管活性药物时间、ICU停留时间、机械通气时间。结果治疗72 h后,观察组与对照组APACHEⅡ评分、ALT、WBC、IL-6、SCr、CRP、血乳酸水平均较治疗前改善(P<0.05),且观察组改善优于对照组(P<0.05)。观察组与对照组平均动脉压均明显高于治疗前(P<0.05),且观察组高于对照组(P<0.05)。观察组心血管活性药物使用时间、ICU停留时间、机械通气时间明显少于对照组(P<0.05)。观察组生存率87.5%(35/40),与对照组的70.0%(28/40)比较,差异无统计学意义(P>0.05)。结论早期持续高容量血液滤过联合血液灌流治疗严重脓毒症,有助于减轻肝肾功能损伤,控制感染,缩短ICU、机械通气时间。Objective To explore the curative effect of early continuous high volume hemofiltration combined with blood perfusion on severe sepsis. Methods Eighty patients with severe sepsis were randomly divided into observation group or control group, with 40 cases in each group. Both groups were given anti-infection bundle therapy. Additionally, early continuous high volume hemofiltration combined with blood perfusion was conducted in the observation group. Before treatment and after 72 hours of treatment, acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） score, mean artery pressure, and levels of WBC, ALT, serum creatinine （ Scr）, C-reactive protein （CPR）, interleukin-6（IL-6） ,and blood lactic acid were determined in the two groups. Twenty eight-day survival rate,medication duration of vasoactive drugs,ICU stay, and duration of mechanical ventilation were calculated. Results After 72 hours of treatment, the APACHE Ⅱ score, levels of ALT, WBC, IL-6, Scr, CRP and blood lactic acid were significantly improved in both groups （P 〈 0.05）, and the improvement was more obvious in the observation group than in the control group （ P 〈 0.05 ）. Mean arterial pressures of both groups were significantly higher after treatment （P 〈 0.05 ）, and the increase in the observation group was more significant. The medication duration of vasoactive drugs, ICU stay,and duration of mechanical ventilation of the observation group were significantly less than those of the control group（P 〈0.05）. The survival rate was 87.5% （35/40） in the observation group ,and 70.0% （28/40） in the control group,with no significant difference （P 〉0.05）. Conclusion Early continuous high volume hemofihration combined with blood perfusion for the treatment of severe sepsis could relieve liver and kidney dysfunction,control infection,and shorten ICU stay and duration of mechanical ventilation.

关 键 词：脓毒症 血液滤过 血液灌流 疗效 早期 高容量血液滤过 联合治疗 

分 类 号：R631.1[医药卫生—外科学]