连续性血液净化治疗重症脓毒症合并应激性心肌病疗效分析

Efficacy of continuous blood purification in treatment of severe sepsis and stress related cardiomyopathy

目的探讨连续血液净化(CBP)对重症脓毒症合并应激性心肌病患者的疗效。方法回顾性收集2012年1月至2014年1月60例重症脓毒症合并应激性心肌病患者,分为常规治疗组30例和血液净化组30例,分析2组治疗前、治疗后24、48、72 h相关血流动力学及72 h炎症感染指标变化。结果CBP治疗后患者平均动脉压、心率、每搏输出量、左心室射血分数和氧合指数(Pa O2/Fi O2)均较治疗前有所改善(P<0.05);与常规治疗组相比,CBP治疗组在C-反应蛋白、降钙素原、白细胞介素-6、脑利钠肽及血乳酸等指标均降低(P<0.05),氧合指数上升(P<0.05),急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)亦降低(P<0.05)。结论对于重症脓毒症合并应激性心肌病患者采用连续性血液净化治疗,在早期能有效清除炎症因子,维持血流动力学稳定,改善氧合功能。

Objective To investigate the efficacy of continuous blood purification（CBP） in treatment for pa-tients with severe sepsis and stress related cardiomyopathy. Methods Sixty patients with severe sepsis and stress related cardiomyopathy hospitalized in ICU between January 2012 and January 2014 were retrospectively included in the study, and divided in the conventional treatment group（n=30） and the blood purification group（n=30）. The related haemodynamics at 24, 48 and 72 h and the inflammatory infection parameter at 72 h before and after the treatment between the two groups were analyzed. Results The mean arterial blood pressure, heart rate, stroke volume, left ventricular ejection fraction, and oxygenation index（Pa O2/Fi O2） in patients were significantly improved after CBP treatment compared with those before the treatment（P〈0.05）. Compared with the conventional treatment group, the creactive protein, procalcitonin, interleukin-6, brain natriuretic peptide and blood lactic acid were significantly decreased（P〈0.05）, whereas the oxygenation index increased（P〈0.05）, and the acute physiology and chronic health evaluationⅡ（APACHEⅡ） decreased significantly in CBP group（P〈0.05）. Conclusion The therapy of CBP can effectively remove inflammatory factors, keep stable haemodynamics, and improve oxygenated function in patients with se-vere sepsis and stress related cardiomyopathy in early phase.