脉冲式高容量血液滤过在严重脓毒症患者中的应用

Application of pulse high volume hemofiltration in severe sepsis patients

目的探讨脉冲式高容量血液滤过在严重脓毒症患者中的应用价值。方法严重脓毒症患者49例,按照随机原则分为:A组25例(脉冲式高容量血液滤过组),B组24例(持续高容量血液滤过组),进行不同方法的血液滤过治疗,记录开始和72h后APACHEⅢ评分,平均动脉压(MAP),血管活性药用量,凝血功能,生化指标,炎症指标的变化。还记录每组患者的滤器平均使用时间,置换液使用总量,肝素使用总量,28d病死率等数据,进行比较分析。结果治疗72h后,A,B两组之间平均动脉压,去甲肾上腺素用量,炎症指标水平差异均没有统计学意义(P>0.05)。B组使用的置换液量比A组明显增多,滤器平均使用时间明显缩短,B组血小板下降,APTT延长,血红蛋白下降的程度与A组比较差异有统计学意义(P<0.05)。结论在严重脓毒症患者中,脉冲式高容量血液滤过,可以达到持续高容量血液滤过的效果,又可以节约液体,耗材,减少对血液,凝血系统的影响。

Objective To investigate the advantages of pulse high volume hemofiltration in severe sepsis patients. Methods A total of 49 severe sepsis patients were divided randomly into 2 groups： group A, treated with pulse high volume hemofiltration （n=25）; group B, treated with continuous high volume hemofiltration （n=24）. APACHE Ⅲ score, mean artery pressure （MAP）, vasoactives administration, blood coagulation function, biochemistry parameters, inflammation markers were monitored before and after the treatment for 72 hours. Average dialysis time, amount of dialysate exchanged, heparin used, and mortality rate in a 28 day period were compared between the 2 groups. Results There were no statistically significant differences in MAP, norepinephrine used, and inflammation markers after the treatment for 72 hours between the 2 groups （P 〉 0.05）. However, patients in group B used more amount of exchanged dialysate, and had shorter dialysis time, less blood platelet, longer APTT, and lower hemoglobin, as compared with those in patients in group A （P 〈 0.05）. Conclusions Pulse high volume hemofiltration has the similar effects as continuous high volume hemofiltration in the treatment of severe sepsis patients, but with less amount of exchanged dialysate and fewer influences on blood components and blood coagulation.