持续静脉-静脉血液滤过联合血液灌流治疗重症脓毒血症的效果观察

Effects of continuous venous - venous hemofiltration plus hemoperfusion for patients with severe sepsis.

目的观察持续静脉-静脉血液滤过联合血液灌流对重症脓毒血症患者的临床疗效及细胞因子的影响，探讨持续静脉-静脉血液滤过联合血液灌流对重症脓毒血症患者的治疗效果。方法20例行持续静脉-静脉血液滤过联合血液灌流的重症脓毒血症患者为研究对象，比较其治疗前、后生命体征、急性生理和慢性健康评分系统评分、白细胞、氧分压、肝、肾功能和细胞因子TNF—α、IL—1、IL-8水平的变化。结果持续静脉-静脉血液滤过联合血液灌流治疗后的重症脓毒血症患者其临床指标与治疗前比较明显改善，细胞因子TNF-α、IL-1、IL-8的水平与治疗前比较明显降低，差异有统计学意义（P〈0．05）。结论持续静脉-静脉血液滤过联合血液灌流能改善重症脓毒血症患者的临床指标，降低重症脓毒血症患者细胞因子水平，可改善重症脓毒血症患者的预后。

Objective To observe the effects of continuous venous - venous hemofiltration plus hemoperfusion on the vital sign, A- PACHE Ⅱ , white blood cell, partial pressure of oxygen, hepatic function, renal function and cytokines in patients with severe sepsis and to in- vestigate the therapeutic action of CVVH ＋ HP for patients with severe sepsis. Methods Twenty patients with severe sepsis underwent CVVH ＋ HP were brought into trial. The vital sign, APACHE Ⅱ , white blood cell, partial pressure of oxygen, hepatic function, renal function and the levels of TNF - α, IL - 1, IL - 8 in patients with severe sepsis were measured before CVVH ＋ HP and after CVVH ＋ HP respectively. Results The vital sign, APACHE Ⅱ , white blood cell, partial pressure of oxygen, hepatic function and renal function were improved after CVVH ＋ HP treatment. The levels of TNF - α, IL - 1 and IL - 8 in patientswith severe sepsis after CVVH ＋ HP were lower than those before CVVH ＋ HP （ P 〈 0. 05 ）. Conclusion CVVH ＋ HP could improve clinical picture and decrease the levels of cytokines in patien^s with severe sepsis, and ameliorate the survival rate of severe sepsis patients.