间歇性高容量血液滤过治疗严重脓毒症的临床观察

Clinical observation on intermittent high volume hemofiltration treatment of severe sepsis

目的:探讨间歇性高容量血液滤过(PHVHF)治疗严重脓毒症的疗效及应用。方法:将25例严重脓毒症患者随机分为PHVHF组13例、对照组12例。PHVHF组给予常规治疗,同时给予PHVHF治疗;对照组只给予常规治疗。观察治疗前、后急性生理学与慢性健康状况(APACHE)Ⅱ评分;心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)等血流动力学指标;血液生化指标(BUN、Cr、K+、Na+、Cl-);氧合指数(PaO2/FiO2);机械通气时间、ICU内治疗时间,28d病死率。结果:PHVHF组治疗后HR、BUN、Cr、K+、PaO2/FiO2、APACHEⅡ评分均较治疗前显著改善(P<0.05),其中,治疗后BUN、Cr、PaO2/FiO2、APACHEⅡ评分两组比较,差异有统计学意义(P<0.05);PHVHF组机械通气时间、ICU内治疗时间短,28d病死率低,其中,ICU内治疗时间,两组患者比较,差异有统计学意义(P<0.05)。结论:PHVHF能稳定血流动力学,并通过对内环境调节、改善氧合等,对多个器官起到支持作用,可减轻严重脓毒症的病情及改善预后,且操作简便,是严重脓毒症的有效治疗手段。

Objective： To investigate the treatment effectiveness and application of pulse high volume hemoflitration （PHVHF） in patients with severe sepsis. Methods： The 25 patients with severe sepsis were randomly divided into PHVHF group 13 cases and control group 12 cases.PHVHF group was given conventional treatment, while giving PHVHF treatment; the control group received conventional therapy only. Observed before and after treatment of acute physiology and chronic health conditions（APACHE）Ⅱ score; heart rate（HR）, mean arterial pressure（MAP）, central venous pressure （CVP） and other hemodynamic parameters;blood biochemical parameters （BUN,Cr,K^＋,Na^＋,Cl^-）;oxygenation index（PaO2/FiO2）;mechanical ventilation time,ICU treatment time period,28 days mortality. Results： After treatment,PHVHF group＇s HR,BUN,Cr, K^ ＋,PaO2/ FiO2, APACHE Ⅱ score was significantly improved than that before treatment（ P〈0.05）,which,after treatment,BUN,Cr, PaO2/FiO2, APACHE Ⅱ score between the two groups,the difference statistically significant（P〈0.05）;PHVHF group of mechanical ventilation,ICU treatment within a short time,28 days mortality rate was low,which ICU treatment time between the two groups of patients,the difference was statistically significant（P〈0.05）. Conclusion： PHVHF can stabilize hemodynamics and homeostasis,improve oxygenation to multiple organ and play a supporting role,can reduce severe disease and improve the prognosis of sepsis,and the simple,severe sepsis is effective treatment.