连续肾替代治疗在外科严重脓毒症并发毛细血管渗漏综合征中的治疗价值

目的 探讨连续肾替代治疗在外科严重脓毒症毛细血管渗漏中的临床治疗价值.方法 38例脓毒症患者按治疗方案不同分为实验组和对照组,对照组常规综合治疗,实验组在常规综合治疗的基础上加连续肾替代治疗.分别监测两组患者治疗后（0、12、24、48、72 h）红细胞计数、血红蛋白含量、血小板计数、白细胞计数、红细胞压积、血浆白蛋白含量变化.中心静脉压（CVP）、有创动脉压（ABP）、每小时尿量变化、氧合指数情况.血清IL-6、IL-8、TNF-α水平变化.结果 实验组血小板计数、红细胞压积、血浆白蛋白含量明显高于对照组72 h：（211.75±45.23）×109 vs（135.67±41.45）×109;0.43±0.05 vs 0.35±0.04;（48.60±4.76）g/L vs（41.17±4.64）g/L,P〈0.01],白细胞计数低于对照组72 h：（7.58±2.31）×109 vs（13.77±2.67）×109,P〈0.01],有创动脉压（ABP）、氧合指数P02／Fi02、每小时尿量变化高于对照组72 h：（94.25±8.60）mmHg vs（84.22±7.37）mmHg;345.25±35.21 vs 304.22±38.74;（80.15±14.54）ml vs（62.72±12.33）ml,P〈0.01],血清IL-6、IL-8、TNF-α水平显著低于对照组（72 h：249.55±99.60 vs 368.83±97.11;600.75±98.31 vs 718.94±92.00;665.35±138.44 vs 843.22±123.95,P〈0.01,P〈0.05）.结论 连续肾替代治疗是治疗外科严重脓毒症毛细血管渗漏的有效治疗方法,明显改善患者病情.

The therapeutic value of continuous renal replacement therapy on severe sepsis coincidence with capillary leak syndrome in surgical patients

Objective To investigate the clinical therapeutic value of CRRT on severe sepsis coincidence with capillary leak syndrome in surgical patients. Methods 38 patients suffering from severe sepsis coincidence with capillary leak syndrome were random divided into routine group ( n = 18 ) and CRRT group ( n =20). Both groups were given routine treatment, while the patients of CRRT group were given CRRT in addition. Red blood cell count (RBC), haematoglobin level, blood platelets count, leukocyte count, hematocrit (HCT), plasma-albumin level, central venous pressure ( CVP), arterial blood pressure ( ABP), urinary production change of every hour, oxygenation index condition ( PO2\FiO2 ) were measured at 0, 12, 24, 48,72 hour following routine treatment or CRRT. Additionally, serum levels of tumor necrosis factor- a (TNF-α), interleukin-6 (IL-6) and interleukin-8(IL-8) were determined at the same time. Results Blood platelets count, HCT, plasma-albumin level in CRRT group were significantly higher than those of routine group 72 h: (211. 75 ± 45. 23 ) × 109 vs ( 135.67 ± 41.45 ) × 109 ;0. 43 ± 0. 05 vs 0. 35 ±0. 04; (48. 60 ±4. 76) g/L vs (41.17 ±4. 64) g/L, P <0. 01 ]. WBC were significantly lower than those of routine group72 h:(7.58 ±2.31) ×109 vs (13.77 ±2.67) × 109, P <0.01]. Change of ABP, PO2\FiO2, urinary production for every hour was notably increased than those of routine group 72 h: (94. 25 ±8.60) mmHg vs ( 84. 22 ± 7. 37 ) mmHg; 345. 25 ± 35. 21 vs 304. 22 ± 38. 74; ( 80. 15 ± 14. 54 ) ml vs (62. 72 ± 12. 33) ml, P <0. 01 ]. The serum levels of TNF-α, IL-6 and IL-8 of CRRT group were markedly decreased compared with those of routine group(72 h:249. 55 ±99. 60 vs 368. 83 ±97. 11 ;600. 75 ±98. 31 vs 718. 94 ± 92. 00 ;665. 35 ±138. 44 vs 843. 22 ±123. 95 , P <0. 01,P <0.05). Conclusions CRRT can significantly improve patient's condition, which may be an effective nechanism to treat the surgical patients with severe sepsis coincidence with capillary leak syndrome.