脉冲式高容量血液滤过对胃肠肿瘤术后腹腔感染的疗效观察

Clinical observation on pulse high volume hemofiltration treatment for abdominal infection after gastrointestinal cancer surgerynal surgery

目的观察脉冲式高容量血液滤过(Pulse high volume hemofiltration,PHVHF)对胃肠肿瘤术后腹腔感染的疗效及应用。方法将40例胃肠肿瘤术后并发腹腔感染患者随机分为PHVHF组20例,对照组20例。PHVHF组给予常规治疗及PHVHF治疗,对照组只给予常规治疗。观察治疗前后患者心率(HR),平均动脉压(MAP)及急性生理学与慢性健康状况(APACHE)II评分,ICU治疗时间,28d病死率。结果 PHVHF组治疗后心率(HR)、尿素氮(BUN)、肌酐(Cr)、血钾(K+)、氧合指数(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组患28d病死率低,差异有统计学意义(10.0%±0.8%和22.0%±0.7%,t=4.305,P=0.036)。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,可减轻胃肠肿瘤术后腹腔感染的病情及改善预后,是有效的治疗手段。

Objective To investigate the effect of pulse high volume hemofiltration （PHVHF） in patients with abdominal infection after gastrointestinal cancer surgery.Methods Forty patients with abdominal infection after gastrointestinal cancer surgery were randomly divided into PHVHF group （n=20） and control group （n=20）.Routine therapy was conducted to both groups of patients,with the addition of PHVHF to the patients in PHVHF group.APACHE Ⅱ score,heart rate （HR）,mean arterial pressure,blood biochemical parameters （BUN,Cr and K＋）,oxygenation index （PaO2/FiO2）,treatment period in ICU,and mortality within 28days were assayed before and after the treatment.Results In PHVHF group after the treatment,HR,BUN,Cr,K＋,PaOgFiO2,and APACHE Ⅱ score improved significantly （P＜0.05）.The improvement of BUN,Cr,PaO2/FiO2 and APACHE Ⅱ score was more prominent in PHVHF group than in control group （P＜0.05）.Mortality within 28 days was lower in PHVHF group （10.0％40.8％） than in control group （22.0％±0.7％; t=4.305,P=0.036）.Conclusion PHVHF stabilizes hemodynamics and homeostasis,improves oxygenation,and plays a supporting role to multiple organs,thus alleviates disease conditions,and improves prognosis in abdominal infection patients after gastrointestinal cancer surgery.