连续性血液净化治疗感染性休克疗效分析

Study on application of continuous blood purification for patients with severe septic shock

目的报告用连续性血液净化（CBP）治疗感染性休克，并探讨其疗效。方法在综合治疗的同时，辅以CBP治疗。所有患者留置中心静脉导管及动脉导管测中心静脉压和平均动脉压，检测动脉血乳酸。滤器为AV600，置换液配方为0．9％NaCl3000ml、5％葡萄糖170ml、注射用水820ml、10％caCl26．4ml、50％MgS041．6ml装入4L输液袋，制成4L／袋的成品（A液部分）。使用前根据患者血钾水平适量加入10％KCl与5％NaHC03250ml（B液部分），由不同的通路按（4000mlA液：250mlB液）同步输入，以免发生沉淀。5％NaHC03在整个治疗过程中匀速补充，以纠正酸中毒。置换液流量为4L／h，首次连续治疗48～72h，以后根据病情再决定CBP。结果治疗前后患者的pH值、氧合指数、动脉血乳酸浓度、平均动脉压等指标明显改善；在多巴胺停用48h内血压正常者共6例，72h内共10例，合并多器官功能衰竭（MODS）8例，其中4例在感染休克后48h后作CBP治疗。共治愈19例，死亡7例，死亡7例中并发MODS5例。结论CBP治疗感染性休克是行之有效的方法；经CBP治疗，死亡率有明显降低，但应尽早进行。

Objective Investigata the efficacy of continuous blood purification（CBP）, in treating patients with septic spock. Method 26 patients with septic shock were enrolled. They were treated with comprehensive therapy according to Therapeutic Guideline about Severe infection and septic shock of 2004, and CBP. of large area, high flux , high blood flow and high volume was given which lasted at least for 72 hours. Results Dopamine was dscontinusd in six cases 48 hours after imitiation of CPB treatment, 10 in 72 hours, 8 were complicated with MODS, among them 4 （farted） CPB treatment 48 hours after diagnosed as septic shock. Among all the patients, 19 were cured, and 7 died, among them 5 complicated with MODS. Conclusions CBP is a effective measuke in treatment of septic shock. The mortality is 27%, which is greatly reduced, and it should be performed as early as possible, and it should be canied according to the guideline.