高容量血液滤过在严重脓毒症中的应用研究

目的 探讨连续性血液净化中的高容量血液滤过(HVHF)技术对严重脓毒症患者的治疗作用.方法 20例外科脓毒症患者行连续性静脉-静脉HVHF,置换量3000～4000 ml/h,均以前稀释方式输入,血流量250～300 ml/min,每天连续进行10～12 h.于HVHF治疗后24、48、72 h各时间点分别行APACHEⅡ评分,并测定心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)等血流动力学参数和肺动态顺应性(Cdyn)及气道阻力(Raw);抽血检测血液电解质(BUN、SCr、Glu、Na+、K+、Cl-);行血气分析,计算出氧合指数(PaO2/FiO2);ELISA法测定细胞因子,包括TNF-α、IL-6、IL-10.结果 与治疗前比较,APACHE Ⅱ评分在治疗后48 h明显降低(P＜0.05),HR、Raw、BUN、SCr、K+、TNF-α、IL-6和IL-10在HVHF治疗后24、48、72 h时均下降(P均＜0.05),PaO2、PaO2/FiO2和Cdyn在HVHF治疗后24、48、72 h时均升高(P均＜0.05),其余各项指标均无显著改变.结论 HVHF能稳定血流动力学,并通过对内环境调节、改善氧合等,对多个器官起到支持作用,有益于减轻脓毒症病情的严重程度及改善预后.

Application of high volume hemoflitration in patients with severe sepsis

Objective To investigate the treatment effectiveness of high volume hemofiltration(HVHF)in patients with severe sepsis.Methotis Twenty patients with severe sepsis underwent HVHF for 10-12 hours every day.The uhrafiltrate rate was set at 3000-4000 ml/h and blood flow at 250-300 ml/min.and the substitute fluid was infused with predilution.The heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),dynamic compliance(Cdyn)and resistance of airway(Raw)were recorded at 24,48 and 72 h during HVHF.The levels of BUN,SCr,Glu,Na+,K+,Cl-and PaO2 were tested,then PaO2/FiO2 was calculated.The levels ofTNF-α,IL-6 and IL-10 were tested by ELISA.Results The APACHE Ⅱ scores were lower than pre-HVHF at.48 hour after HVHF (P＜0.05).HR,Raw,BUN,SCr,K+,TNF-α,IL-6 and IL-10 at 24,48 and 72 h during HVHF decreased significantly compared with those of pre-HVHF(P＜0.05).PaO2、PaO2/FiO2 and Cdyn at 24,48 and 72 h during HVHF increased significantly compared with those of pre-HVH(P＜0.05).No significant difference Was found in the other parameters.Conclusion HVHF has the characteristics of hemodynamic stability.and can regulate the internal environment and improve oxygenation,thus playing a positive role to multiple organs,and reduces the severity of the sepsis as well as improves the prognosis.