脉冲式胶体输注联合连续性血液净化治疗重度毛细血管渗漏综合征的疗效观察

目的观察脉冲式胶体输注联合连续性血液净化（CBP）治疗重度毛细血管渗漏综合征（CLS）的疗效。方法按随机原则将严重脓毒症并出现毛细血管渗漏患者分为常规对照组21例、CBP1组18例和CBP2组22例。三组患者均按2008年脓毒症全球治疗指南的早期集柬化治疗方案进行治疗，常规对照组采用脉冲式胶体输注加速尿治疗；CBP1组和CBP2组均行连续性静一静脉血液滤过（CVVH），治疗72h，CBP1组同时给予胶体集中输入加速尿治疗，CBP2组采用脉冲式胶体输注加胶体后脱水治疗。分别于治疗前及治疗24、48、72h行动脉血气分析，无创心排检测，测定血清血管生成素2（Ang-2）含量，并观察患者ICU住院时间、机械通气时间及28d病死率。结果CBP2组ICU住院时间及机械通气时间均显著短于常规对照组及CBPI组（P〈0．05），28d病死率明显低于常规对照组及CBP1组（P〈0．05）。治疗72h后，CBP2组与CBP1组APACHEU评分均明显下降，CBP2组下降程度优于CBP1组（P〈0．05）。CBP2组治疗后24、48、72h氧合指数均较治疗前明显增高（P〈0．05），且较常规对照组（24、48、72h）及CBP1组（48、72h）同期明显增高（P〈0．05或P〈0．01）。CBP2组治疗后24、48、72h肺水含量均较治疗前明显降低（P〈0．05），且较常规对照组（24、48、72h）及CBP1组（48、72h）同期明显降低（P〈0．05或P〈0．01）。CBP2组治疗后24、48、72h血清Ang-2浓度均较治疗前明显降低（P〈0．05），且较常规对照组（24、48、72h）及CBP1组（48、72h）同期明显降低（P〈0．05或P〈0．01）。结论脉冲式胶体输注联合血液净化能明显减轻严重脓毒症患者毛细血管渗漏，改善预后。

Effect of Pulsed Colloid Infusion Combined with Continuous Blood Purification for Treatment of Severe Capillary Leak Syndrome

Objective To investigate the effect of pulsed colloid infusion combined with continuous blood purification （CBP） for treatment of severe capillary leak syndrome （CLS）. Methods According to random principle ,61 patients were divided into a control group（ n = 21 ）, a CBP1 group（ n = 18 ） and a CBP2 group（n = 22）. All patients of three groups received routine treatment according to international guidelines 2008 for management of severe sepsis. The patients in the control group also received pulsed infusion colloid combined lasix. The patients in the CBP1 and CBP2 groups also received continuous veno-venous hemofiltration（CVVH） for 72 hours. The patients in the CBP1 group received concentrated colloid infusion combined lasix, and the patients in the CBP2 group received concentrated colloid infusion combined removing fluid. Blood gas analysis and Impedance Cardiography was performed before and 24,48 and 72 hours after therapy. The angiopoietin-2 （Ang-2） was measured. Also the length of ICU stay, duration of mechanical ventilation, and death rate of patients in 28 days were observed. Results Compared with the control group and the CBP1 group, the length of ICU stay （days） and duration of mechanical ventilation （days） in the CBP2 group were significantly shorter（P 〈 0. 05 ）,and the death rate in 28 days was lower（P 〈 0. 05 ）. The patients in the CBP2 group showed more reduction in the APACHE Ⅱ score compared with the CBP1 group after therapy （P 〈 0. 05）. The oxygenation index in the CBP2 group respectively increased at 24,48 and 72 hours after therapy（P 〈 0. 05 ）. Compared with the control group and the CBP1 group, the oxygenation index in the CBP2 group respectively increased at the same time（P 〈0. 05）. The thoracic fluid content （TFC） in the CBP2 group respectively decreased at 24,48 and 72 hours （ P 〈 0. 05 ） after therapy, and decreased compared with the control group and the CBP1 group at the same time （ P 〈 0. 05 ）. The serum levels of Ang-2 in the CBP2 group respectively decreased at 24,48 and 72 hours after therapy （ P 〈 0. 05 ）, and decreased compared with the control group and the CBP1 group at the same time （ P 〈 0. 05 ）. Conclusion Pulsed colloid infusion combined with continuous blood purification can reduce the severity of capillary leak and improves the outcome of patients with severe sepsis.