持续血液滤过联合血液灌流治疗脓毒血症合并急性肾功能衰竭的疗效观察

目的：观察持续静脉-静脉血液滤过（CVVH）联合血液灌流（HP）治疗脓毒血症合并急性肾功能衰竭（急性肾衰）的疗效.方法：回顾分析2009年9月～2012年8月在院脓毒血症合并急性肾衰患者57例,所有患者均给予抗感染、液体复苏、机械通气、控制血糖、营养支持等综合对症治疗.按治疗方法分为对照组和治疗组.对照组患者行CVVH治疗,血流速度为200ml/min,置换液采取前稀释法输入,3L/h.采用低分子肝素抗凝.1次/24h,连续治疗3次.观察组患者在给予CVVH治疗的基础上联合HP治疗,血流速度为180ml/min.采用低分子肝素抗凝.1次/24h,连续治疗3次.分别于治疗前、治疗72h后采集静脉血检查患者血浆内毒素、白介素-6（IL-6）、肿瘤坏死因子（TNF-α）、降钙素原（PCT）等指标水平.观察患者的临床症状和转归,观察4周.结果：与治疗前比较,2组患者PCT、血浆内毒素、IL-6、TNF-α等指标水平均下降;观察组较治疗前显著降低（P＜0.05）.与对照组比较,观察组死亡率显著降低（P＜0.05）.两组患者治疗后,存活患者临床指标无显著性差异（P＞0.05）.结论：采用CVVH联合HP治疗脓毒血症合并急性肾衰疗效满意,可明显降低死亡率.

A clinical study of continuous veno-venous hemofiltration and hemoperfusion in treatment of severe sepsis

Objective ：To observe the effect of continuous vent-venous hemofihration（CVVH）and hemoperfusion （HP）in treatment of severe sepsis.Methods：Choose 57 cases from Sep.2009 to Aug.2012 in the hospital as research object,according to the principle of voluntary grouping,control group with CVVH therapy.Observation group with CVVH and HP.The two groups before and after treatment of plasma inflammatory,cytokine level changes and mortality differences were observed.Results：Compared with before treatment ,two groups of patients with plasma endotoxin,procalcitonin,interleukin-6,tumor necrosis factor-a level indicator were decreased,observation group decreased greatly,with significant statistical difference （P〈0.05）.Compared with control group, observation group significantly lower mortality,with significant statistical difference （P〈0.05）.Conclusion：CVVH and HP in treatment of severe sepsis with satisfactory results,which reduce mortality,in patients with economic conditions could recommend to use.