高容量血液滤过对重症急性胰腺炎循环、呼吸的影响

Effect of high volume hemoflitration on circulation and respiration in patients with severe sepsis

目的探讨连续性血液净化中的高容量血液滤过(HVHF)技术对重症急性胰腺炎患者的治疗作用。方法20例重症急性胰腺炎患者行连续性静脉-静脉HVHF,置换量3000～4000ml/h,均以前稀释方式输入,血流量250～300 ml/min,连续进行72 h以上,每24小时更换一次滤器及血路。于HVHF治疗后24、48、72 h分别行APACHEⅡ评分,并测定心率(HR)、平均动脉压(MAP),中心静脉压(CVP)、肺动态顺应性(Cdyn)和气道阻力(Raw);行血气分析,计算出氧合指数(PaO2/Fi O2)。结果HVHF治疗后48 h APACHEⅡ评分低于治疗前水平(P<0.05);HR显著减慢;PaO2、PaO2/Fi O2和Cdyn在HVHF治疗后24、48、72 h时均显著升高(P<0.05);Raw在HVHF治疗后各时间点均显著下降(P<0.05)。结论HVHF能稳定血流动力学,并通过对内环境调节、改善氧合等,从而对多个器官起到支持作用,有益于减轻病情的严重程度及改善预后。

Objective To investigate the effect of high volume hemofiltration（HVHF）on circulation and respiration in patients with severe acute pancreatitis（SAP）.Methods Twenty patients with SAP underwent HVHF for 72 hours.The ultrafiltrate rate was set at 3000～4000ml/ h and blood flow at 250～300ml/min.The substitute fluid was infused before dilution.Hemofilter was changed every 24 hours.The heart rate（HR）,mean arterial pressure（MAP）,central venous pressure（CVP）,dynamic compliance（Cdyn） and resistance of airway（Raw） were recorded at 24,48 and 72h during HVHF.Blood gas analysis was performed and ratio of PaO2/ FiO2 was calculated.Results The APACHEⅡscores were lower at 48hour after HVHF than those before（P〈0.05）.HR was significantly decreased after HVHF.There was no significant difference in pH,PaCO2 after HVHF compared with those before（P〉0.05）.But PaO2,PaO2/FiO2,Cdyn were increased and Raw decreased significantly after HVHF（P〈0.05）.Conclusion HVHF has the characteristics of hemodynamic stability and homeostasis,and improvement of oxygenation.Thus the severity of sepsis is reduced and the prognosis is improved.