连续性血液净化对严重感染综合征救治价值研究

Continuous blood purification in the treatment of surgical severe sepsis patients

目的探讨连续性血液净化(CBP)治疗普通外科严重感染综合征的临床价值。方法回顾性分析中山大学附属第一医院SICU在2006-01-01—2007-12-31期间52例接受CBP治疗的严重感染综合征(severe sepsis)病人资料。结果CBP治疗时间(13.5±29.4)d,在CBP治疗期间分别采用低分子质量肝素抗凝11例(21.2%)、体外肝素抗凝13例(25.0%)、无抗凝19例(36.5%),未发生严重出血并发症。52例病人好转16例(30.8%),自动放弃治疗19例(36.5%),ICU内死亡17例(32.7%)。抗凝方式、手术类型、感染部位等对CBP疗效影响差异无统计学意义。结论CBP是外科严重感染综合征病人重要治疗措施之一,治疗过程中应采取个体化抗凝方案。

Objective To study the category of anticoagulant during the.treatment of continuous blood purification in surgical severe sepsis patients and research the influence of the operation and infection on the effect of CBP. Methods All severe sepsis patients who underwent CBP in the SICU of the First Affiliated Hospital of Sun Yet-sea University, from January 2006 to December 2007, were analysed retrospectively. Results A total of 52 patients were included （42 males and 10 females） with the age of 60. 8± 16.0 years,and the time of CBP was 13.5 ±29.4 days. Eleven cases （21.15%） were anticoagulated with low molecular weight heparin,13 cases （25.00%） with heparin in vitro,19 cases （32. 69% ） completed the CBP without anticoagulant. The bleeding associated with anticoagulation was not observed. The impact of anticoagulation, operation and infection on the curative effect of CBP wasnt different significantly. Conclusion CBP is a impertant therapy for surgical severe sepsis patients. The modality of anticoagulation should be individualization in the process of CBP.