持续高容量血液净化治疗对脓毒症休克患者血乳酸水平影响  

Effect of HVHF on level of blood lactic acid and 6h lactic clearance rate in patients with severe sepsis

作　　者：杨建旭[1] 

机构地区：[1]河南省人民医院ICU,郑州450000

出　　处：《医药论坛杂志》2016年第12期37-39,共3页Journal of Medical Forum

摘　　要：目的探讨高容量血液净化与常规剂量治疗对重症脓毒症患者的血乳酸水及6 h乳酸清除率的影响。方法本研究为前瞻性随机对照研究。82例脓毒症休克患者随机分为两组,即标准（传统）剂量血液滤过组38例（CVVH组）、高剂量血液滤过组44例（HVHF组）。置换液量分别为35 m L/（kg·h）和80 mL/（kg·h）,血流量为160-250 ml/min,每天持续进行10 h以上。两组于分别于治疗前及治疗后6、24、48、72 h检测动脉血乳酸水平,记录相应时间点的急性生理和慢性健康状态评分（APACHEⅡ评分）,并计算6 h血乳酸清除率;比较两组患者ICU滞留时间以及28 d病死率。结果与CVVH组比较,HVHF组患者各时间点的血乳酸水平和APACHEⅡ评分均降低,结果有统计学意义（P均〈0.05）。6 h乳酸清除率增加,ICU住院时间缩短,结果均有统计学意义（P〈0.05）。28 d病死率有降低趋势,差异无统计学意义。结论重症脓毒症患者,HVHF治疗能有效降低血乳酸水平,缓解病情的严重程度,缩短ICU住院时间。Objective To investigate the clinical efficacy of continuous of high volume hemofiltration（ HVHF） on the level of blood lactic acid and 6 h lactic clearance in patients with severe sepsis. Methods Totally 82 cases of sepsis patients were divided into control group（ n = 38） and observation group（ n = 44）. The two groups were all treated by continuous blood purification. Control group had standard dosage volume [35 ml mL/（ kg·h） ],while observation group had larger volume [80 mL/（ kg·h） ]. Comparing arterial blood lactic level and APACHE Ⅱ score on admission and 6,24,48 and 72 h after treatment. 6h blood lactic clearance rate,the period of stay in ICU,28-days mortality were calculated and compared too. Results Arterial blood lactic level and APACHE Ⅱ score were lower in the observation group in all the five time point（ P＜0. 05）. 6 h blood lactic clearance rate was higher in the observation group（ P＜0. 05）. Observation group had an shorter period of stay in ICU than control group. While,there showed no significant difference of28-days mortality in the two groups. Conclusion HVHF may decreased blood lactic acid level,shorten ICU residence time in patients with severe sepsis.

关 键 词：重症脓毒症 血乳酸 6h乳酸清除率 HVHF 

分 类 号：R459.7[医药卫生—急诊医学]