早期高容量血液滤过对重症脓毒症的影响

Early high-volume hemofiltration treatment in severe sepsis

目的：评价高容量血液滤过（high-volume hemofiltration treatment,HVHF）在早期重症脓毒症患者中的疗效。方法：将30例符合国际诊断标准的重症脓毒症患者纳入本研究,按照脓毒症集束治疗指南进行干预,在确诊24 h内行HVHF治疗,每日连续给予床旁HVHF治疗12~18 h,连续观察72 h。比较治疗前和治疗24 h、48 h、72 h后各时间点动脉血乳酸值、血清细胞因子（IL-6、IL-10）、C反应蛋白（CRP）和氧代谢指标[动脉血pH值、氧和指数（PaO2/FiO2）]等。结果：HVHF治疗24 h、48 h、72 h后脓毒症患者动脉血乳酸值和血清IL-6均明显降低（P〈0.05）,IL-10无明显变化（P〉0.05）,CRP在HVHF治疗48 h后显著下降,氧代谢指标得到明显改善（P均〈0.05）。结论：HVHF可通过清除血乳酸、促炎因子,减轻脓毒症患者过度的炎症反应,改善组织细胞的氧代谢。

Objective： To evaluate the effect of early application of high-volume hemofiltration treatment（HVHF）on the levels of lactic acid,pro-inflammatory cytokines and C-reactive protein（CRP） in plasma,as well as APACHEⅡscore in patients suffering from severe sepsis.Methods： Thirty patients meeting the diagnosis of severe sepsis were enrolled in the trial within 24 hours of insults.The level of lactic acid,interleukin-6（IL-6） and CRP in plasma were measured before HVHF and at 24,48 or 72 h following HVHF treatment.Results： The plasma levels of lactic acid and IL-6 decreased significantly at 24 h,48 h,72 h after HVHF（P0.05）,while,IL-10 did not differ significantly following HVHF（P0.05）,when compared with that before HVHF.Conclusion： The early application of HVHF could clear the plasma lactic acid and pro-inflammatory cytokines,and improve the tissue oxygenation in severe sepsis.