高容量血液滤过技术在脓毒症治疗中的应用

目的 探讨高容量血液滤过技术对脓毒症患者的治疗作用.方法 将20例脓毒症患者完全随机分为血液滤过组和常规治疗组,各10例.2组均予常规治疗.血液滤过组患者在此基础上行高容量血液滤过,置换液流量为2 000 ～3 000 ml/h,血流量为80 ～ 120 ml/min,每天持续进行12 h以上.2组于治疗前、治疗后48 h进行急性生理与慢性健康Ⅱ评分,记录心率、平均动脉压,检测肿瘤坏死因子α、白细胞介素6并进行比较分析.结果 2组患者治疗后急性生理与慢性健康状况Ⅱ评分均下降,与治疗前比较差异有统计学意义血液滤过组：（12.5±4.2）比（20.8±2.9）;常规观察组：（16.1±1.9）比（21.3±3.3）,P＜0.05],血液滤过组治疗后心率与平均动脉压与常规治疗组治疗后比较,差异均有统计学意义（108±17）次/min比（132 ±27）次/min,（83±13）mmHg（l mmHg =0.133 kPa）比（172±19） mmHg;均P＜0.05].常规治疗组的肿瘤坏死因子α、白细胞介素6治疗前后比较,差异无统计学意义（P＞0.05）.结论 高容量血液滤过在治疗脓毒症过程中,能够清除部分炎性因子,患者血流动力学稳定,是一种有效的治疗方法.

High volume hemofiltration treating sepsis

Objective To investigate the effect of high volume hemofiltration （HVHF） on sepsis patients.Methods Twenty patients were divided randomly into HVHF group （10 cases） and conventional treatment group （10 cases） ; both groups received regular treatment.HVHF was applied in treatment group for more than 12 h daily.The replacement flow rate was （2 000-3 000）ml/h and the blood flow rate was （80-120）ml/min.Acute physiology and chronic health evaluation （APACHE Ⅱ）,heart rate （HR）,mean artery pressure （MAP）,tumor necrosis factor α （TNF-α） and interleukin-6 （IL-6） were recorded.Results APACHE Ⅱ was decreased after treatment in both groups （P 〈 0.05）,with a significant decrease after 48 h treatment in the HVHF group.Campared with conventional treatment,HR and MAP in HVHF group after treatment had significant decrease （108 ± 17） times/rmin vs （132 ±-27） times/min,（83 ± 13） mmHg vs （172 ± 19） mmHg,P 〈 0.05].No significant changes of these parameters were found in the control group （P 〉0.05）.Conclusion HVHF can remove inflammatory factors and ameliorate sepsis.