摘要
【摘要】目的探讨早期连续血液滤过（ continuous veno-venous hemofiltration, CVVH）对脓毒性休克肺循环通透性的影响。方法选取浙江省立同德医院重症医学科2010年6月至2011年12月确诊脓毒性休克患者51例，随机（随机数字法）分为：常规治疗组（A组，27例），CVVH治疗组（B组，24例），B组在A组的治疗基础上完成72hCVVH，比较两组治疗前后气道平台压（Pplat）、肺顺应性（Cst）、氧合指数（PaO2／FiO2）、血管外肺水指数（ extravascular lung water index，EVLWI）及E．选择素的变化。结果①治疗后两组患者Pplat均呈下降趋势，在48、72h同时间点比较B组低于A组（t=2．215，P〈0．05；t=4．266，P〈0．01）；Cst在治疗后呈上升趋势，48、72h比较B组高于A组（t=2．516，P〈0．05；t=3．052，P〈0．01）。②治疗后两组患者PaO2／FiO2均呈上升趋势，48、72hB组高于A组（t=2．732，P〈0．01；t=3．511，P〈0．01）。③治疗后两组患者EVLWI均呈下降趋势，48、72h同时间点B组低于A组（t=2．597，P〈0．05；t=2．125，P〈0．05）。治疗后ITBVI、CI、SVRI及MAP组间比较差异无统计学意义（P〉0．05）。④治疗后两组患者E-选择素均呈下降趋势，48、72h同时间点B组低于A组（t=2．154，P〈0．05；t=3．581，P〈0．01）。结论早期CVVH治疗能改善脓毒性休克患者的肺血管通透性，减少EVLWI，改善肺氧合功能和肺顺应性，对血流动力学无影响。
Objective To investigate the effect of continuous veno-venous hemofihration （CVVH） on pulmonary vascular permeability in the early stage of septic shock . Methods Fifty-one patients of septic shock admitted in intensive care unit of the First Affiliated Hopsital of Medical College, Zhejiang University between June 2010 and December 2011 were randomized into two groups by simple random method. Routine treatment was carried out to patients in group A, and routine treatment plus CVVH to patients in group B in the first 72 hours. Repeated respiratory mechanic hemodynamic measurements were done at baseline （Tb） before treatment, at 48 hours （ T48 ） and 72 hours （ T72 ） after the treatment. Pulmonary compliance （Cst）, platform pressure （Pplat）, oxygenation index （PaO2/FiO2 ）, extravascular lung water index （EVLWI） and E-selectin determined at each time point were recorded in two groups. Results （1） Pplat were decreased significantly after treatment in two groups, and the Pplat in group B were all lower than thosein group A at T48 and T72 （ t = 2. 215, P 〈 0. 05 ; t = 4. 266, P 〈 0. 01 ）. Cst were elevated after treatment in two groups, and Cst in group B were all higher than those in group A at T48 and T72 （t =2. 516, P 〈 0. 05; t = 3. 052, P 〈 0. 01 ）. （2） Compared to before treatment, PaO2/FiO2 increased significantly after treatment in two groups, and PaO2/FiO2 in group B were all higher than those in group A at T48 and T/2 （t =2. 732, P 〈0. 01 ; t =3. 511, P 〈0. 01）. （3）EVLWI were decreased significantly after treatment in two groups, and the EVLWI in group B were all lower than those in group A at T48 and T72 （ t = 2. 597, P〈0.05; t=2. 125, P 〈0.05）. ITBVI, CI, SVRI and MAP did not change over time in two groups compared with those at Tb （ all P 〉 0. 05 ）. （4） E-selectin were decreased significantly ＇,after treatment in two groups, and the E-selectin in group B were all lower than those in group A at T48 and T72 （t =2. 154, P
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2012年第11期1251-1256,共6页
Chinese Journal of Emergency Medicine
基金
浙江省医药卫生科技计划（2010KYA045）
关键词
血液滤过
脓毒性休克
肺循环
通透性
Continuous veno-venous hemofiltration
Septic shock
Pulmonary circulation
Permeability
