连续性血液透析滤过联合血液灌流治疗感染性休克的效果  

Treatment Effect of Septic Shock by Continuous Hemodialysis and Hemoperfusion

作　　者：周燕瑜 黄庭龙[1] ZHOU Yanyu;HUANG Tinglong(Department of Intensive Care Medicine,The Second Affiliated Hospital of Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属第二医院重症医学科,福建泉州362000

出　　处：《中国医药指南》2023年第14期86-88,共3页Guide of China Medicine

摘　　要：目的 探讨感染性休克患者采取连续性血液透析滤过联合血液灌流进行治疗的可行性。方法 将福建医科大学附属第二医院2020年1月至2022年6月收治的90例符合入组标准的重症医学科(ICU)住院患者按随机数表法分为对照组(常规治疗)、Ⅰ组(连续性血液透析滤过治疗)、Ⅱ组(连续性血液透析滤过联合血液灌流治疗),每组30例,统计3组患者28 d生存率、机械通气时间、血管活性药物使用时间、ICU住院时间,比较3组患者治疗前和治疗24、48、72 h后的心率、氧合指数、体温、血常规、血乳酸、凝血功能和血肌酐的差异。结果 Ⅱ组在改善氧合指数方面效果优于Ⅰ组,Ⅰ组和Ⅱ组在减慢心率、降低体温方面差异无统计学意义,但两组效果均明显优于对照组(P <0.05)。Ⅱ组在降低白细胞计数方面的效果优于Ⅰ组。Ⅰ组和Ⅱ组在清除血乳酸、降低血肌酐方面差异无统计学意义,但两组效果均明显优于对照组(P <0.05)。Ⅱ组机械通气时间、血管活性药物使用时间、ICU住院时间均明显短于对照组,血管活性药物使用时间明显短于Ⅰ组(P <0.05),Ⅱ组28 d生存率为70.00%,明显高于对照组(P <0.05)。结论 连续性血液透析滤过联合血液灌流能促进感染性休克患者器官功能快速恢复,临床效果优,且没有明显出血风险,安全性高。Objective To explore the feasibility of contiguous veno-venous hemodialysis(CVVHDF)combined with hemoperfusion(HP)for treatment of septic shock patients.Methods Ninety patients admitted to the Second Affiliated Hospital of Fujian Medical University from January 2020 to June 2022 from the intensive care unit(ICU)inpatients were randomly divided into control group(conventional treatment),groupⅠ(CVVHDF),groupⅡ(CVVHDF combined HP),30 cases in each group.The 28 d survival rate,mechanical ventilation time,vasoactive drug use time and ICU stay time of the three groups were analyzed,and the differences of heart rate,oxygenation index,body temperature,blood routine,blood lactic acid,coagulation function and serum creatinine were compared between the three groups before treatment and 24 h,48 h and 72 h after treatment.Results The effect of groupⅡon improving oxygenation index was better than that of groupⅠ.There was no significant difference between groupⅠand groupⅡin slowing down heart rate and lowering body temperature,but the effect of both groups was significantly better than that of control group(P<0.05).GroupⅡwas better than groupⅠin reducing leukocyte count.There was no significant difference between groupⅠand groupⅡin scavenging blood lactic acid and reducing blood creatinine,but the effect of both groups was significantly better than that of control group(P<0.05).Mechanical ventilation time,vasoactive drug use time and ICU stay time of groupⅡwere significantly shorter than control group,and vasoactive drug use time was significantly shorter than groupⅠ(P<0.05).The 28-day survival rate of groupⅡwas 70.00%,significantly higher than control group(P<0.05).Conclusion Continuous hemodialysis combined with hemoperfusion can promote the recovery of organ function in septic shock patients,the clinical effect is better,and there is no obvious bleeding risk,high safety.

关 键 词：感染性休克 连续性血液透析滤过 血液灌流 出血 

分 类 号：R631.4[医药卫生—外科学]