不同的血液净化模式治疗脓毒症多脏器功能衰竭患者的疗效分析

Effect analysis of different blood purification treatment on sepsis patients with mutiple organ failure

目的 探讨脉冲式高容量血液滤过（PHVHF）和连续性静脉-静脉血液滤过（CVVH）两种模式在脓毒症多脏器功能衰竭患者救治中的临床价值.方法 53 例脓毒症多脏器功能衰竭患者随机分为两组,PHVHF 组 27 例, CVVH 组 26 例.于治疗前和治疗后24 小时比较两组的循环状态（HR、MAP）,肺功能改善（PO2、PO2/FiO2）尿素氮（ BUN）、肌酐（ SCr ）的变化.结果 两组患者治疗后较治疗前体温、 BUN 及SCr 均明显下降（ P〈0.01 ）,但组间比较差异无统计学意义.两组治疗后较治疗前PaO2/FiO2 明显升高,PHVHF 组（253.4±55.9）vs （173±44.5）; CVVH 组：（218.1±40.2）vs （178±35.3） （ P〈0.01 ）,PHVHF 组较 CVVH 组氧合改善更明显（ P〈0.01 ）.两组治疗前后比较：HR水平变化差异无统计学意义,MAP 的改善PHVHF 组明显优于CVVH 组,差异有统计学意义.结论 PHVHF 及CVVH 两种模式均能清除炎性介质,减轻机体的炎症反应, PHVHF 较 CVVH 能更快地稳定循环,减少血管活性药物的应用,改善氧和指数,清除体内代谢废物,降低基础代谢率,最终改善脓毒症患者的预后.

Objective To detect the clinical value of pulse high-volume hemofiltration （PHVHF） and Continuous veno-venous hemofiltration（CVVH） in treating sepsis patients with multiple organ failure. Methods We selected 53 sepsis patients with multiple organ failure., who were randomlydivided into two groups PHVHF group and CVVH group. The clinical outcomes between the two groups were evaluated with Circulatory state（HR、MAP）,pulmonary improving state and changes of Creatinine, urea nitrogen. Results The body temperature, creatinine and urea nitrogen of all patients ofthe two groups were significantly reduced after treatment（P〈0.01）,while there is no therapeutic statistical difference between PHVHF group and CVVHgroup. PaO2/FiO2 in both groups were significantly increased than before treatment, with PHVHF group was （253.4±55.9）vs （173±44.5）and CVVHgroup was（218.1±40.2）vs （178±35.3）（P〈0.01）. Oxygenation improvement was more obvious in PHVHF group than in CVVH group（ P〈0.01 ）.There was no difference on HR, but the MAP improvement in PHVHF group was significantly better than in CVVH group, with statistical difference.Conclusion Both PHVHF and CVVH can Remove inflammatory mediators, reduce inflammatory response. PHVHF can stable circulation, reduce theuse of vasoactive drugs, improve the oxygen index, remove metabolic waste, reduce basal metabolic rate more quickly, and ultimately improve theprognosis of sepsis patients.