血液灌流联合血液滤过治疗脓毒性休克患者的临床疗效研究

Clinical effects of combination of hemoperfusion(HP) and continuous veno-venous hemofiltration(CVVH) in patients with septic shock

目的研究血液灌流(hemoperfusion,HP)联合连续性静脉-静脉血液滤过治疗(continuous veno-venous he-mofiltration,CVVH)对脓毒性休克(septic shock)患者的临床疗效,探讨HP联合CVVH对脓毒性休克患者的治疗作用。方法采用随机、对照的方式,将我科2009年9月～2010年8月收的APACHEII评分≥15分的36例脓毒性休克患者,分为对照组(C组)、CVVH组(V组)、HP+CVVH组(H组),每组各12例,分别进行常规治疗、常规治疗+CVVH治疗、常规治疗+HP+CVVH治疗,比较各组28d存活率、SOFA评分、生命体征、血流动力学、肺部氧合及其它器官功能的变化。结果C组、V组、H组28d存活率分别为41.67%、58.33%、66.67%,有所提高,但3组间差异无统计学意义。与C组相比,V组从第4d起SOFA评分即明显降低(P<0.05),H组第2d起SOFA评分即明显降低(P<0.05)。与C组相比,V组从第4d起氧合指数即明显升高(P<0.05),H组第2d起氧合指数即明显升高(P<0.05),且在第2d、3d,H组较V组明显升高(P<0.05)。与C组相比,V组及H组血管活性药物使用时间、呼吸机使用时间明显缩短;增快的心率、血白细胞、高体温明显下降、酸中毒明显纠正(P<0.05);血糖、血乳酸、血肌肝、尿素氮、谷草转氨酶、胆红素均明显降低(P<0.05);但纤维蛋白原(Fib)、凝血酶原时间(PT)、血红蛋白(Hb)、血小板(PLT)均无明显变化(P>0.05)。结论 VVH及HP+CVVH治疗均能促进脓毒性休克患者器官功能恢复,且以HP+CVVH治疗效果更佳。HP+CVVH治疗对患者凝血系统无明显影响,不良反应小。

Objective To investigate the clinical effects of combination of hemoperfusion（HP） and continuous veno-venous hemofiltration（CVVH） in patients with septic shock.Methods 36 patients with septic shock and their acute physiology and chronic health evaluation II（APACHEII） 15,were randomly assigned to control group（C group）/Continuous veno-venous hemofiltration group（CVVH group）/hemoperfusion and Continuous veno-venous hemofiltration group（HP ＋CVVH group）,with roution therapy /roution and CVVH therapy/roution and HP and CVVH therapy respectively.And the difference survival rate for 28 days,sepsis related organ failure assessment（SOFA）,the vital sign,hemodynamic parameter,oxygenation index,and other organ functions were evaluated.Results 1.The 28d survival rate of the Group C,Group V and the Group H were 41.67%,58.33%,66.67%,but Differences among the groups were not statistically significant.2.The SOFA Score in Group V were lower than in group C from the fourth day on（P〈0.05）.It was also lower in group H than group C from the second day on（P〈0.05）.3.The oxygenation index was increased from the 4th day in group V compared with group C（P〈0.05）.The oxygenation index in group H was higher than group C from the second day（P〈0.05）,and was higher than group V in the second and third day（P〈0.05）.4.As compared with group C,the time of breathing machine and vasoactive agent use was reduced in group H and group V,but no differences were seen between the two groups（P〈0.05）.As compared with group C,the heart rate,the WBC,the body temperature was decreased,the PH value in group V was increased,the blood glucose,lactic acid,Cr,UN,AST,DB were all decreased（P〈0.05）,and the Fib,PT,Hb,PLT were not statistically significant（P〈0.05）,in group H and group V.Conclusion Both the CVVH and the HP＋CVVH can promote the recovery of organ function,and the HP＋CVVH may has better effects.3.The HP＋CVVH doesn＇t influence the function of blood coagulation,which indicating there are no significant adverse effects involved.