摘要
目的探讨严重脓毒症早期应用持续高容量血液滤过(CHVHF)联合血液灌流(HP)对患者预后的影响。方法 60例本院收治的由各种病因导致的严重脓毒症或脓毒症休克患者。按照《2008拯救严重脓毒症和脓毒症休克治疗指南》推荐的标准治疗基础上,随机分3组,A组采取CHVHF联合HP治疗,B组采取CHVHF治疗,C组仅采取标准治疗。CHVHF采用相同治疗剂量,45ml·kg-1·h-1,连续72h不间断。HP使用一次性血液灌流器每12h更换1次,每次治疗时间2h。血流动力学监测指标:有创血压、心排血指数。CHVHF治疗即刻(0h)、治疗6h、24h、治疗结束后分别留取动脉血及混合静脉血标本,检查血常规、血生化、血气分析等。血浆炎症细胞因子检测:CHVHF治疗前(0h)、治疗6h、24h及治疗结束后留取静脉血标本,ELISA测定IL-1、IL-6、IL-10、肿瘤坏死因子α(TNF-α)。结果所有治疗均顺利进行,治疗前后,A、B组与C组比较,血浆内IL-1、IL-6、IL-10、TNF-α水平均有下降(P<0.05)。A、B组间比较,A组炎症细胞因子清除效率更高,血流动力学稳定更快,早期病死率下降(P<0.05)。结论 CHVHF联合HP能改善重症脓毒血症患者的血流动力学状况,提高患者的存活率,是一种可行、有益的辅助治疗重症脓毒血症及脓毒血症休克的方法。
Objective The impact of continuous high capacity hemofiltration(CHVHF)combined with hemoperfusion(HP)on hemodynamic in early stage of sepsis was considered.Methods A total of 60 severe sepsis or sepsis shock patients were enrolled.According to 'The guide on severe sepsis or sepsis shock patients saving 2008',patients were randomized to group A,who received CHVHF(45 ml·kg-1·h-1)for a 72-hour period combined with HP for a 12-hour period with 2-hour one time,or group B who received continuous high capacity hemofiltration,or group C who were managed conventionally.Hemodynamic monitoring index composed of invasive blood pressure and heart row blood index.Artery and mixed venous blood specimen was saved after CHVHF(0 h,6 h,24 h),and the test of routine blood,blood biochemical,and blood gas analysis was carried on.Plasma inflammatory cytokine detection:venous blood specimen was saved after CHVHF(0 h,6 h,24 h),ELISA detection of IL-1,IL-6,IL-10,TNF-α was carried on.Results Treatment process was carried on smoothly,and with the treatment,compared with group A,group B and group C,the degree of IL-1,IL-6,IL-10 and TNF-α in plasma was decline(P<0.05),compared with group B,in group A clearing efficiency of inflammatory cytokine was higher,the hemodynamic stabilize faster,and the early fatality was reduced.Conclusions The CHVHF combined with HP can improve the condition of hemodynamic,increases patient surial,which is a feasible and beneficial auxiliary treatment method on severe sepsis and sepsis shock patients.
出处
《中华临床医师杂志（电子版）》
CAS
2012年第14期3976-3980,共5页
Chinese Journal of Clinicians(Electronic Edition)
