连续性血液净化对合并心肌损伤的感染性休克患者心功能及组织灌注的影响

Effects of Continuous Blood Purification on Cardiac Function and Tissue Perfusion in Patients with Septic Shock Complicated Myocardial Injury

目的观察连续性血液净化(CBP)对合并心肌损伤的感染性休克患者心功能及组织灌注的影响。方法选择40例合并心肌损伤的感染性休克患者行连续性静脉静脉血液滤过治疗,治疗期间用PiCCO监测记录血管外肺水指数(EVLWI)肺血管通透指数(PVPI)及反映心功能的指标脑利钠肽、肌钙蛋白I与组织灌注指标水平的变化。结果随着治疗时程的延长,患者血管外肺水指数与肺血管通透指数指数明显下降(P<0.01),心功能指标脑利钠肽及肌钙蛋白I有明显下降(P<0.01),组织灌注的指标血乳酸(Lac)、中心静脉血氧饱和度(ScVO2)、动静脉二氧化碳分压差(P(cv-a)CO2)有明显下降(P<0.01)。结论 CBP可改善合并心肌损伤的感染性休克患者心功能及组织灌注水平。

Objective To observe the effects of CBP on cardiac function and tissue perfusion in patients with septic shock complicated myocardial injury. Methods 40 patients merged myocardial injury with septic shock were treated with CVVH. EVLWI and PVPI were measured or calculated at scheduled intervals using PiCCO,and at the same time recorded the changes of the parameters of reflection of cardiac function that BNP,cTnI as well as tissue perfusion level. Results With the extension of the schedule,EVLWI and PVPI of the patients decreased obviously（ P〈 0.01）,the level of BNP and cTnI had significantly lower（ P〈 0.01）,the parameter of tissue perfusion that Lac,ScVO2,P（ CV-a） CO2had significantly lower（ P〈 0.01）. Conclusions Cardiac function and tissue perfusion of the patients merged myocardial injury with septic shock can benefit from the treatment of CBP.