高容量血液滤过对严重脓毒症血流动力学和氧代谢的影响

Effect of High Volume Hemofiltration on Hemodynamics and Oxygen Metabolism in Severe Sepsis

目的探讨高容量血液滤过(HVHF)对严重脓毒症患者的血流动力学和氧代谢的影响。方法选择由各种病因导致的25例严重脓毒症或脓毒症休克患者,每日在床边行连续HVHF(置换液流量80ml.kg-1.h-1)治疗12～18h。观察治疗后24、48、72h患者心率(HR)、平均动脉压(MAP)、心脏指数(CI)、体温和动脉血氧合指数(PaO2/FiO2)。观察治疗前后急性生理与慢性健康评分Ⅱ(APACHEⅡ)、序贯器官衰竭评估(SOFA)评分的变化。结果HVHF治疗48h～72h时严重脓毒症患者的HR、MAP、体温和PaO2/FiO2等指标均与治疗前差异有统计学意义(P<0.05),HVHF治疗72h后,APACHEⅡ评分和SOFA评分较HVHF治疗前差异有统计学意义(P<0.05)。结论HVHF治疗可以有效改善严重脓毒症或脓毒症休克患者的血流动力学,降低患者的APACHEⅡ评分和SOFA评分。

Objective To investigate the effect of continuous high volume hemofihration （HVHF） on hemodynamics and oxygen metabolism in severe sepsis patients. Methods Twenty five adult patients with severe sepsis received HVHF （80ml · kg^-1 · h ^-1）, 12 -18 hours/d. Heart rate （HR）, mean arterial pressure （MAP）, cardiac index （CI）, temperature and oxygenation index （PaO/FiO2） were determined after 24, 48, 72 hours of treatment. The changes of Acute Physiology and Chronic Health Evaluation II （APACHE II） and Sequential Organ Failure Assessment （SOFA） were observed before treatment and after. Results HR, MAP, temperature and PaO,/FiO2 were improved significantly after 48 to 72 hours of HVHF in patients with severe sepsis or septic shock （ P 〈0. 05 ）. The scores of APACHE II and SOFA decreased significantly after 72 - hour HVHF （ P 〈 0.05）. Conclusion HVHF can improve effectively hemodynamics and lower the scores of APACHE II and SOFA in patients with severe sepsis or septic shock.