比较液体复苏与连续静脉-静脉血液滤过对脓毒性休克患者血气指标、炎性因子水平的改善作用  

To Compare the Improvement Effects of Fluid Resuscitation and Continuous Veno-venous Hemofiltration on Blood Gas Indexes and Inflammatory Factors in Patients with Septic Shock

作　　者：陈福英 CHEN Fuying(Xiamen Hongai Hospital,Xiamen 361000,China)

机构地区：[1]厦门市弘爱医院,福建厦门361000

出　　处：《中国医药指南》2023年第36期28-31,共4页Guide of China Medicine

摘　　要：目的以脓毒性休克患者作为研究对象,就其分别采用液体复苏和连续静脉-静脉血液滤过(CVVH)作为治疗方法的临床效果进行深入分析和探讨。方法从我院2021年9月至2022年9月收治的脓毒性休克患者中,抽取80例进行回顾性分析,根据不同的治疗方法将其分为两组,采用液体复苏治疗的患者纳入对照组(40例),在液体复苏的基础上联合CVVH治疗的患者纳入观察组(40例)。对比两组的治疗效果。结果对照组与观察组治疗前后的p H值均无明显差异(P>0.05);观察组治疗3 d后的碱剩余(BE)水平高于对照组,乳酸(Lac)水平低于对照组(P<0.05);治疗3 d后,观察组的C反应蛋白(CRP)(t=3.642,P=0.001)、肿瘤坏死因子-α(TNF-α)(t=2.704,P=0.008)、白细胞介素-6(IL-6)(t=3.546,P=0.001)、白细胞介素-10(IL-10)(t=3.247,P=0.002)与对照组相比均较低(P<0.05);对照组与观察组的24 h去甲肾上腺素用量无明显差异(P>0.05);观察组的ICU住院时间、机械通气时间均短于对照组,且24 h输液量少于对照组,28 d多器官功能综合征(MODS)发生率和28 d病死率低于对照组(P<0.05)。结论脓毒性休克患者在液体复苏的基础上联合CVVH治疗的效果较显著,不仅可以有效改善患者的血气指标,还可以减轻其炎性反应,提高预后。Objective The clinical effects of fluid resuscitation and continuous veno-venous hemofiltration(CVVH)in septic shock patients were analyzed and discussed.Methods A total of 80 patients with septic shock admitted to our hospital from September 2021 to September 2022 were selected for retrospective analysis and divided into two groups according to different treatment methods.Patients receiving liquid resuscitation were included in the control group(n=40),and patients receiving combined CVVH on the basis of liquid resuscitation were included in the observation group(n=40).The therapeutic effect of the two groups was compared.Results There was no significant difference in pH value between control group and observation group before and after treatment(P>0.05).The alkali residual(BE)of the observation group was higher than those of the control group,and lactic acid(Lac)of the observation group was lower than those of the control group after 3 d treatment(P<0.05).After 3 days of treatment,C-reactive protein(CRP)(t=3.642,P=0.001),tumor necrosis factor-α(TNF-α)(t=2.704,P=0.008),interleukin-6(IL-6)(t=3.546,P=0.001),interleukin-10(IL-10)(t=3.247,P=0.002)were lower than those in the control group(P<0.05).There was no significant difference in the dosage of norepinephrine at 24 h between control group and observation group(P>0.05).The duration of ICU stay and mechanical ventilation in observation group was shorter than that in control group,and the amount of infusion at 24 h was less than that in control group.The incidence of multiple organ function syndrome(MODS)at 28 d and mortality at 28 d in observation group were lower than those in control group(P<0.05).Conclusions The combined treatment of CVVH on the basis of fluid resuscitation in septic shock patients has a significant effect,which can not only effectively improve the blood gas index,but also reduce the inflammatory response and improve the prognosis.

关 键 词：脓毒性休克 液体复苏 连续静脉-静脉血液滤过 血气指标 炎性因子 

分 类 号：R631.4[医药卫生—外科学]