连续性血液净化治疗对严重脓毒症患者血乳酸水平及血流动力学的影响

Effect of continuous blood purification therapy on blood lactate level and hemodynamics in patients with severe sepsis

目的研究连续性血液净化治疗(CBPT)对严重脓毒症患者血乳酸水平及血流动力学的影响。方法选择2013年9月至2016年12月重症医学科收治的60例严重脓毒症患者,随机分为研究组和对照组各30例。对照组给予常规治疗,研究组在对照组基础上给予连续性血液净化治疗。分别记录和分析两组患者在刚入院时、治疗后6h、治疗后24 h、治疗后48 h、治疗后72 h的急性生理与慢性健康评分(Acute Physiology,Age and Chronic Health,APACHEⅡ评分)和血液乳酸值,记录入院3天后的各项生理指标:心率(Heart rate,HR)、平均动脉压(Mean arterial pressure,MAP)、心脏指数(cardiac index,CI)、全身血管阻力指数(systemic venous resistance index,SVRI)。将两组患者的治疗时间、病死率、1个月内脏器功能正常的天数等情况进行对比。结果两组患者经过治疗后血乳酸水平和APACHEⅡ评分均有改善,治疗后24 h、48 h、72 h研究组的血乳酸水平和APACHEⅡ评分改善情况优于对照组(P<0.01)。入院时,两组HR、MAP、CI、SVRI比较差异无统计学意义(P>0.05);治疗后72小时,两组CI、HR比治疗前降低(P<0.01),研究组SVRI高于对照组(P<0.05)。研究组的治疗时间短于对照组(P<0.05),1个月内脏器无障碍天数多于对照组(P<0.05),两组病死率比较差异无统计学意义(P>0.05)。结论连续血液净化结合常规方法治疗严重脓毒症患者,既能改善患者的血流动力学情况,又能加快病情缓解,值得推广。

Objective To study the influence of continuous blood purification therapy on blood lactate level and hemodynamics in patients with severe sepsis.Methods60cases of severe sepsis admitted to ICU from September,2013to December,2016were selected and randomly divided into study group and control group,with30cases in each group.The control group were given routine treatment,and the study group were given continuous blood purification therapy on the basis of the control group.Then,the APACHEⅡscores(Acute Physiology,Age and Chronic Health)and blood lactate values of the two groups were respectively recorded and analyzed at the time of admission,6h after treatment,24h after treatment,48h after treatment and72h after treatment.In addition,the following physiological indexes were recorded3days after admission:HR(heart rate),MAP(mean arterial pressure),CI(cardiac index)and SVRI(systemic vascular resistance index).The treatment time,mortality rate and days of normal visceral function in one month were compared between the two groups.Results After treatment,APACHEⅡscores and blood lactate values of the two groups improved,and24h,48h and72h after treatment,those of the study group improved more significantly than those of the control group(P<0.01).At the time of admission,difference of HR,MAP,CI and SVRI values was not statistically significant(P>0.05).72h after treatment,CI and HR values of both groups reduced compared with those before treatment(P<0.01),and SVRI value of the study group was higher than that of the control group(P<0.05).The treatment time of the study group was shorter than that of the control group(P<0.05),and days of normal visceral function in one month were more than the control group(P<0.05).Difference of mortality rate of the two groups was not statistically significant(P>0.05).Conclusion The application of continuous blood purification combined with conventional treatment in patients with severe sepsis can not only improve hemodynamics but also accelerate the relief of the disease.Thus,it is worthy of promotion in clinical use.