BACKGROUND：High-volume hemofiltration （HVHF） is technically possible in severe acute pancreatitis （SAP） patients complicated with multiple organ dysfunction syndrome （MODS）. Continuous HVHF is expected to becom...BACKGROUND：High-volume hemofiltration （HVHF） is technically possible in severe acute pancreatitis （SAP） patients complicated with multiple organ dysfunction syndrome （MODS）. Continuous HVHF is expected to become a beneficial adjunct therapy for SAP complicated with MODS. In this study, we aimed to explore the effects of fluid resuscitation and HVHF on alveolar- arterial oxygen exchange, the Acute Physiology and Chronic Health Evaluation II （APACHE II） score in patients with refractory septic shock. METHODS：A total of 89 refractory septic shock patients, who were admitted to ICU, the Provincial Hospital affiliated to Shandong University from August 2006 to December 2009, were enrolled in this retrospective study. The patients were randomly divided into two groups： fluid resuscitation （group A, n=41）, and fluid resuscitation plus high-volume hemofiltration （group B, n=48）, The levels of O2 content of central venous blood （CcvO2）, arterial oxygen content （CaO2）, alveolar-arterial oxygen pressure difference P（A-a）DO2, ratio of arterial oxygen pressure/alveolar oxygen pressure （PaO2/ PAO2）, respiratory index （RI） and oxygenation index （OI） were determined. The oxygen exchange levels of the two groups were examined based on the arterial blood gas analysis at different times （0, 24, 72 hours and 7 days of treatment） in the two groups. The APACHE II score was calculated before and after 7-day treatment in the two groups. The levels of CcvO2, CaO2 on day 7 in group A were significantly lower than those in group B （CcvO2：0.60±0.24 vs, 0.72±0.28, P〈0.05; CaO2：0.84±0.43 vs. 0.94±0.46, P〈0.05）. The level of oxygen extraction rate （O2ER） in group A on the 7th day was significantly higher than that in group B （ 28.7±2.4 vs. 21.7±3.4, P〈0.01）. The levels of P（A-a）DO2 and RI in group B on the 7th day were significantly lower than those in group A. The levels of PaO2/PAO2 and OI in group B on 7th day were significantly higher than those in group A （P〈0.05 or P〈0.01）. The APACHE II score in the two groups reduced gradually after 7-day treatment, and the APACHE II score on the 7th day in group B was significantly lower than that in group A （8.2±3.8 vs. 17.2±6.8, P〈0.01）. HVHF combined with fluid resuscitation can improve alveolar- arterial-oxygen exchange, decrease the APACHE II score in patients with refractory septic shock, and thus it increases the survival rate of patients.展开更多
目的探讨持续血液滤过高容量法对SAP合并ARDS肺功能和血流动力学指标的影响。方法选取该院近年来收治SAP合并ARDS患者90例,采用随机数字表法分为对照组(45例)和观察组(45例);其中对照组患者采用常规对症支持治疗;观察组患者则在此基础...目的探讨持续血液滤过高容量法对SAP合并ARDS肺功能和血流动力学指标的影响。方法选取该院近年来收治SAP合并ARDS患者90例,采用随机数字表法分为对照组(45例)和观察组(45例);其中对照组患者采用常规对症支持治疗;观察组患者则在此基础上加用持续血液滤过高容量法治疗;比较两组患者治疗前后肺功能和血流动力学指标水平,机械通气时间和30 d生存率等。结果对照组患者治疗后24 h和48h肺功能指标水平显著优于治疗前;而观察组患者治疗后6、24和48 h肺功能指标水平均显著优于对照组和治疗前,差异有显著性(P<0.05);对照组患者治疗后48 h HR水平显著优于治疗前,差异有显著性(P<0.05);而观察组患者治疗后24 h和48 h HR水平均显著优于对照组和治疗前,差异有显著性(P<0.05);两组患者治疗前后MAP水平比较差异无显著性(P>0.05);两组患者治疗后炎症因子水平均显著低于治疗前,且观察组患者治疗后炎症因子水平低于对照组,差异有显著性(P<0.05);观察组患者机械通气时间和30 d生存率均显著优于对照组,差异有显著性(P<0.05)。结论持续血液滤过高容量法辅助常规对症支持治疗可有效改善SAP合并ARDS患者肺通气功能,减少机械通气时间,降低死亡率,且无明显血流动力学不良影响。展开更多
基金This study was supported by a grant from the Natural Science Foundation of Shandong Province （Y2006C77）.
文摘BACKGROUND：High-volume hemofiltration （HVHF） is technically possible in severe acute pancreatitis （SAP） patients complicated with multiple organ dysfunction syndrome （MODS）. Continuous HVHF is expected to become a beneficial adjunct therapy for SAP complicated with MODS. In this study, we aimed to explore the effects of fluid resuscitation and HVHF on alveolar- arterial oxygen exchange, the Acute Physiology and Chronic Health Evaluation II （APACHE II） score in patients with refractory septic shock. METHODS：A total of 89 refractory septic shock patients, who were admitted to ICU, the Provincial Hospital affiliated to Shandong University from August 2006 to December 2009, were enrolled in this retrospective study. The patients were randomly divided into two groups： fluid resuscitation （group A, n=41）, and fluid resuscitation plus high-volume hemofiltration （group B, n=48）, The levels of O2 content of central venous blood （CcvO2）, arterial oxygen content （CaO2）, alveolar-arterial oxygen pressure difference P（A-a）DO2, ratio of arterial oxygen pressure/alveolar oxygen pressure （PaO2/ PAO2）, respiratory index （RI） and oxygenation index （OI） were determined. The oxygen exchange levels of the two groups were examined based on the arterial blood gas analysis at different times （0, 24, 72 hours and 7 days of treatment） in the two groups. The APACHE II score was calculated before and after 7-day treatment in the two groups. The levels of CcvO2, CaO2 on day 7 in group A were significantly lower than those in group B （CcvO2：0.60±0.24 vs, 0.72±0.28, P〈0.05; CaO2：0.84±0.43 vs. 0.94±0.46, P〈0.05）. The level of oxygen extraction rate （O2ER） in group A on the 7th day was significantly higher than that in group B （ 28.7±2.4 vs. 21.7±3.4, P〈0.01）. The levels of P（A-a）DO2 and RI in group B on the 7th day were significantly lower than those in group A. The levels of PaO2/PAO2 and OI in group B on 7th day were significantly higher than those in group A （P〈0.05 or P〈0.01）. The APACHE II score in the two groups reduced gradually after 7-day treatment, and the APACHE II score on the 7th day in group B was significantly lower than that in group A （8.2±3.8 vs. 17.2±6.8, P〈0.01）. HVHF combined with fluid resuscitation can improve alveolar- arterial-oxygen exchange, decrease the APACHE II score in patients with refractory septic shock, and thus it increases the survival rate of patients.
文摘目的探讨持续血液滤过高容量法对SAP合并ARDS肺功能和血流动力学指标的影响。方法选取该院近年来收治SAP合并ARDS患者90例,采用随机数字表法分为对照组(45例)和观察组(45例);其中对照组患者采用常规对症支持治疗;观察组患者则在此基础上加用持续血液滤过高容量法治疗;比较两组患者治疗前后肺功能和血流动力学指标水平,机械通气时间和30 d生存率等。结果对照组患者治疗后24 h和48h肺功能指标水平显著优于治疗前;而观察组患者治疗后6、24和48 h肺功能指标水平均显著优于对照组和治疗前,差异有显著性(P<0.05);对照组患者治疗后48 h HR水平显著优于治疗前,差异有显著性(P<0.05);而观察组患者治疗后24 h和48 h HR水平均显著优于对照组和治疗前,差异有显著性(P<0.05);两组患者治疗前后MAP水平比较差异无显著性(P>0.05);两组患者治疗后炎症因子水平均显著低于治疗前,且观察组患者治疗后炎症因子水平低于对照组,差异有显著性(P<0.05);观察组患者机械通气时间和30 d生存率均显著优于对照组,差异有显著性(P<0.05)。结论持续血液滤过高容量法辅助常规对症支持治疗可有效改善SAP合并ARDS患者肺通气功能,减少机械通气时间,降低死亡率,且无明显血流动力学不良影响。
