血液净化对脓毒症患者微循环及血流动力学的影响

The effect of blood purification on microcirculation and hemodynamics in patients with sepsis

目的探讨连续性血液净化(CBP)治疗对脓毒症患者微循环及血流动力学的影响。方法选取我院ICU收治的重度脓毒症和脓毒性休克患者共51例,随机分为观察组(27例)和对照组(24例)。对照组采用常规治疗,观察组在此基础上行CBP治疗。比较两组患者治疗前后血乳酸及血流动力学指标(LVEF、MAP、CO、CI、SVI、SVR、SVRI、TFC)的变化情况。结果治疗72h后,两组患者较治疗前血乳酸明显降低(P<0.05),且观察组的血乳酸低于对照组(P<0.05);两组患者治疗前后血流动力学指标(MAP、LVEF、CI、CO、SVR、SVRI)有显著变化(P<0.05);观察组治疗72h后的MAP、LVEF、CI、CO、SVR、SVRI均高于对照组(P<0.05);观察组的血管活性药物剂量低于对照组(P<0.05);观察组住ICU天数少于对照组(P<0.05)。结论 CBP能稳定重度脓毒症和脓毒性休克患者的血流动力学指标,改善微循环,缩短住院时间。

Objective To investigate the effect of continuous blood purification（CBP） on microcirculation and hemodynamics in patients with sepsis. Methods A total of 51 patients with severe sepsis and septic shock treated in ICU in our hospital were randomly divided into the observation group（27 cases） and the control group（24 cases）. The control group was treated with routine treatment, and the observation group was treated with CBP on this basis. The changes of blood lactic acid and hemodynamic indexes（LVEF,MAP,CO,CI,SVI,SVR,SVRI and TFC） before and after treatment were compared between the two groups. Results After 72 hours of treatment, the blood lactic acid in the two groups was significantly lower than that before the treatment（P〈0.05）, and the blood lactic acid in the observation group was lower than the control group（P〈0.05）. There were significant changes in the hemodynamic indexes（MAP,LVEF,CI,CO,SVR,SVRI） before and after treatment in the two groups（P〈0.05）. The MAP,LVEF,CI,CO,SVR and SVRI of the observation group were all higher than those of the control group（P〈0.05）. The dose of vasoactive drugs in the observation group was lower than the control group（P〈0.05）. Days in ICU of the observation group was less than the control group（P〈0.05）. Conclusion CBP can stabilize the hemodynamic indexes of patients with severe sepsis and septic shock, improve microcirculation and shorten the time of hospitalization.