高容量血液滤过在重症感染性休克治疗中的应用效果观察  

Application of high volume hemofiltration in the treatment of severe septic shock

作　　者：朱伦刚[1] 贾超[1] 汪彦[1] 蒋忠洋[1] ZHU Lun-gang;JIA Chao;WANG Yan;JIANG Zhong-yang(Mianyang Central Hospital, Mianyang 646000, Chin)

机构地区：[1]绵阳市中心医院,绵阳646000

出　　处：《内科急危重症杂志》2018年第1期38-41,共4页Journal of Critical Care In Internal Medicine

摘　　要：目的:探讨高容量血液滤过(HVHF)治疗重症感染性休克患者有效性和安全性。方法:将113例重症感染性休克患者按照不同治疗方案分为治疗1组(n=43)、治疗2组(n=39)和对照组(n=31),对照组给予常规液体复苏治疗,在对照组治疗的基础上,治疗1组在液体复苏治疗6 h内给予HVHF治疗,治疗2组于液体复苏治疗6 h之后给予HVHF治疗。比较3组患者器官功能改善效果、多器官功能障碍综合征(MODS)评分、急性生理与慢性健康状况(APACHEⅡ)评分、炎性因子水平及病死率。结果:治疗后,治疗1组、治疗2组氧合指数、动脉血氧分压(Pa O2)均明显高于对照组,血肌酐、丙氨酸转氨酶(ALT)、总胆红素、血压调整性心率(PAR)、MODS评分、APACHEⅡ评分均明显低于对照组(均P<0.05),治疗1组氧合指数、Pa O2均明显高于治疗2组,血肌酐、ALT、总胆红素、PAR、MODS评分、APACHEⅡ评分均明显低于治疗2组(均P<0.05);治疗后24、48、72 h,治疗1组和治疗2组血清TNF-α、IL-6水平均明显低于对照组(均P<0.05),治疗1组均明显低于治疗2组(P<0.05);治疗1组和治疗2组病死率均明显低于对照组(均P<0.05);治疗1组和治疗2组病死率比较差异无统计学意义(P>0.05)。结论:在液体复苏治疗的基础上给予HVHF可显著改善重症感染性休克患者的器官功能,减少了患者死亡,且早期进行HVHF治疗的效果更加显著,值得临床重视。Objective： To investigate the efficacy and safety of high volume hemofiltration（HVHF） in patients with severe septic shock. Methods： According to different treatment methods,113 patients with severe septic shock were divided into the treatment group 1（n=43）,treatment group 2（n=39） and control group（n=31）. The patients in the control group were treated with conventional liquid resuscitation. On the basis of the treatment of the control group,the patients in the treatment group 1 were treated with HVHF within 6 h after the treatment of liquid resuscitation,and those in the treatment group 2 were treated with HVHF 6 h after fluid resuscitation. The improvement of organ function,MODS score,APACHE score,inflammatory factor levels and mortality were compared among the three groups. Results： After treatment,the oxygenation index and arterial partial pressure of oxygen in the treatment group 1 and treatment group 2 were significantly higher,the serum creatinine,alanine aminotransferase,total bilirubin,PAR,MODS score and APACHE score were significantly lower in the control group（P〈0. 05）. The oxygenation index and arterial partial pressure of oxygen in the treatment group 1 were significantly higher,and the serum creatinine,alanine aminotransferase,total bilirubin,PAR,MODS score and APACHE score were significantly lower than in the treatment group 2（P〈0. 05）. At 24,48 and 72 h after treatment,the serum TNF-alpha and IL-6 in the treatment group 1 and treatment group 2 were significantly higher than those in the control group（P〈0. 05）,and those in the treatment group 1 were significantly lower than those in the treatment group 2（P〈0. 05）; The mortality in the treatment group1 and treatment group 2 was significantly lower than in the control group（P〈0. 05）; There was no significant difference in the mortality between the treatment group 1 and treatment group 2（P〈0. 05）. Conclusion： On the basis of fluid resuscitation,HVHF can significantly improve the organ function

关 键 词：重症感染性休克 高容量血液滤过 治疗时机 临床疗效 

分 类 号：R459.5[医药卫生—治疗学] R541.64[医药卫生—临床医学]