早期高容量血液滤过在重症感染性休克急诊救治中的应用

Application of early high volume hemofiltration in emergency treatment of patients with severe septic shock

目的:探讨早期高容量血液滤过在重症感染性休克急诊救治中的应用价值,分析肝肾功能、血流动力学及炎性因子水平在重症感染性休克中的变化。方法:将2016-01—2018-05收治的90例重症感染性休克患者根据不同救治对策分2组,对照组45例给予综合治疗,观察组45例在液体复苏6h内给予高容量血液滤过治疗,对2组患者肝肾功能、血流动力学及炎性因子水平、多器官功能障碍综合征(MODS)评分、急性生理与慢性健康状况(APACHEⅡ)评分进行观察。结果:2组治疗前血肌酐(Scr)、谷丙转氨酶(ALT)、总胆红素(TBiL)差异无统计学意义(P>0.05),治疗后,观察组上述指标均优于对照组(P<0.05);2组治疗前降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)等炎性因子水平差异无统计学意义(P>0.05),治疗后,观察组上述指标水平明显较对照组低(P<0.05);2组患者治疗前APACHEⅡ及MODS评分差异无统计学意义(P>0.05),观察组治疗后APACHEⅡ及MODS评分均低于对照组,差异有统计学意义(P<0.05);2组患者治疗前心率(HR)、平均动脉压(MAP)、心排血量(CO)、混合静脉血氧饱和度(ScvO2)、体循环血管阻力指数(SVRI)等血流动力学指标差异无统计学意义(P>0.05),治疗后,观察组上述指标均优于对照组(P<0.05)。结论:早期高容量血液滤过可有效改善重症感染性休克患者肝肾功能,并能控制炎性反应,调节血流动力学,利于预后,值得临床应用推广。

Objective:To investigate the application value of early high volume hemofiltration in emergency treatment of severe septic shock,and analyze the changes of liver and kidney function,hemodynamics and inflammatory factors in severe septic shock.Method:A total of 90 cases of patients with severe septic shock treated in Department of emergency from January,2016 to May,2018 were grouped according to different treatment strategies.The control group of 45 cases received comprehensive treatment,while the observation group of 45 cases received high volume hemofiltration within 6 hours of fluid resuscitation.The liver and kidney function,hemodynamics and levels of inflammatory factors,multiple organ dysfunction syndrone(MODS)score,acute physiology and chronic health status(APACHEⅡ)score of two groups of patients were observed.Result:There was no significant difference in serum creatinine(Scr),alanine aminotransferase(ALT)and total bilirubin(TBiL)between the two groups before treatment(P>0.05).After treatment,the above indexes in the observation group were better than those in the control group at the same time(P<0.05).There was no significant difference in procalcitonin(PCT),tumor necrosis factor-alpha(TNF-αlpha),C-reactive protein(CRP)and other inflammatory factors between the two groups before treatment(P>0.05).The levels of inflammatory factors after treatment in the observation group were lower than those in the control group at the same time(P<0.05).There was no significant difference in APACHEⅡscore and MODS score between the two groups before treatment(P>0.05).The APACHEⅡscore and MODS score of the observation group after treatment were lower than those of the control group at the same time,and the difference was statistically significant(P<0.05).There was no significant differences in the hemodynamic parameters such as heart rate(HR),mean arterial pressure(MAP),cardiac output(CO),mixed venous oxygen saturation(Scv O2),systemic vascular resistance index(SVRI)between the two groups before treatment(P>0.05).After treatment,the above indexes in the observation group were better than those in the control group at the same time(P<0.05).Conclusion:The early high volume hemofiltration can effectively improve the liver and kidney function in patients with severe septic shock,control the inflammatory reaction,regulate the hemodynamics,and benefit prognosis,thus it is worth promoting in clinical.