血浆置换联合连续性静脉-静脉血液滤过在ICU血源性危重脓毒症中的应用  

Application of Therapeutic Plasma Exchange combined with Continuous Venovenous Hemofiltration in the Treatment of Critically Ill Patients with Bloodstream Infection in Intensive Care Unit

作　　者：侯六生[1] 梁宏开 李建伟[1] 蒋崇慧[1] 赵湛元[1] 杨婷 徐雪影[1] HOU Liu-sheng;LIANG Hong-kai;LI Jian-wei;JIANG Chong-hui;ZHAO Zan-yuan;YANG Ting;XU Xue-ying(Department of Intensive Care Unit,Zhong shan Affiliated Hospital of Sun Yat-sen University,Zhong shan,Guangdong Province,528400)

机构地区：[1]广东省中山大学附属中山医院重症医学科

出　　处：《岭南急诊医学杂志》2019年第5期427-430,共4页Lingnan Journal of Emergency Medicine

基　　金：广东省中山市科技计划项目（20132a133）

摘　　要：目的:探讨连续性静脉-静脉血液滤过(CVVH)联合血浆置换(TPE)在ICU血源性危重脓毒症中的临床疗效。方法:回顾性分析2012年1月-2017年1月中山大学附属中山医院重症医学科中因血源性危重脓毒症行CVVH治疗的病例,根据患者是否接受TPE治疗,将其分为CVVH组和CVVH+TPE组,比较两组脏器功能、预后转归。结果:456例血源性危重脓毒症患者入选本研究,其中严重脓毒症209例,脓毒性休克247例,男性:女性=0.92,平均年龄(47±13)岁,行血浆置换183例,转出ICU 348例,康复出院336例。CVVH+TPE组谷丙转氨酶、谷草转氨酶、总胆红素、APTT、血尿素氮、血清肌酐及血乳酸明显低于CVVH组,血小板计数、ICU转出率及康复出院率均明显高于CVVH组(P均<0.05)。结论:CVVH联合TPE治疗血源性危重脓毒症,能减轻机体的全身炎症反应,较好地维护机体各脏器功能,可改善ICU血源性危重脓毒症的预后。Objective:To probe the clinical efficacy of therapeutic plasma exchange(TPE)combined with continuous venovenous hemofiltration(CVVH)in the treatment of bloodstream infection critically ill sepsis. Methods:From January 2012 to January 2017,the patients with bloodstream infection critically ill sepsis were retrospectively studied.According to therapeutic schedule,all patients were divided into CVVH group and CVVH+TPE group. The index of organ functions and prognosis was compared in two groups. Results:There were 209 patients with severe sepsis and 247 patients with septic shock. The average age was(47±13)years,183 patients were received CVVH combined with TPE.348 patients were successfully transferred from ICU. 336 patients were successfully discharged. ALT,AST,TBIL,APTT,BUN,Cr and blood lactate in the CVVH+TPE group were significantly lower than those in the CVVH group,while PLT,the rats of transfer from ICU and hospital discharge were significantly higher than those in the CVVH group,all P<0.05.Conclusion:TPE combined with CVVH can alleviate inflammation and protect organ function and improve prognosis for patients with infection critically ill sepsis.

关 键 词：严重脓毒症 脓毒症休克 血浆置换 连续性静脉-静脉血液滤过 

分 类 号：R47[医药卫生—护理学]