上尿路梗阻致脓毒性休克的治疗

Treatment of septic shock from upper urinary obstruction

目的探讨上尿路梗阻（UUO）致脓毒性休克（SS）的治疗方法。方法UUO致SS患者72例。采用快速补液、血管活性药物、小剂量糖皮质激素、广谱抗生素及早期肠道营养等常规治疗30例；常规治疗同时加连续性静脉-静脉血液滤过（CVVH）治疗42例。患者生命体征平稳后行外科治疗解除梗阻。比较2组患者ICU治疗前、治疗24h后急性生理学及慢性健康状况评分Ⅱ（APACHEⅡ）、多器官功能障碍综合征（MODS）评分、治疗干预评分系统（TISS）评分、ICU住院时间和病死率。结果常规组与综合组患者治疗前APACHEⅡ评分（22．1±5．9与21．9±6．0）、MODS评分（7．8±4．3与7．8±4．2）比较差异均无统计学意义（P〉0．05）。治疗24h后2组间APACHEII评分（19．7±5．5与14．8±5．2）、MODS评分（7．3±1．4与4．0±1．2）比较差异均有统计学意义（P〈0．05）。2组转出ICU时TISS评分（51．8±17．4与42．3±16．6）、ICU住院时间[（12．6±6．3）d与5．3±2．6）d]和病死率（46．7％与11．9％）比较差异均有统计学意义（P〈0．05）。ICU治疗后综合组患者病情改善率为88．0％（37／42），常规组为53．3％（16／30）。50例具备行外科手术条件者行B超引导下经皮肾穿刺造瘘或经尿道输尿管镜技术解除梗阻，49例手术治疗痊愈，1例死于心脏骤停。2例拒绝手术治疗者分别死于呼吸衰竭及消化道大出血，1例自动出院。结论CVVH结合外科手术解除梗阻治疗UU0致SS，能提高救治成功率。

Objective To investigate the treatment of septic shock（SS） from upper urinary obstruction（UUO）. Methods Continuous veno-venous haemofihration（CVVH） combined with surgical method was applied to 42 SS patients from UUO. Their general conditions, liver and kidney functions, APACHE II, therapeutic intervention scorisystem（TISS）, multiple organ dysfunction syndrome （MODS）, complication rate and main outcomes were analysed comparing with traditional therapies groups（n= 30）. Results Compared with those traditional therapies, the APACHE H , MODS and TISS score decreased （P〈0.05）. Thirty-seven out of 42 patients survived and the survival rate was 88.0% during ICU. Conclusion CVVH combined with surgical methods may effectively decrease the incidence of complications and mortality of SS from UUO, and the mechanism may be related to the remove of mediators of inflammation.