高容量血液滤过治疗脓毒症合并多器官功能障碍综合征效果分析

[目的]探讨高容量血液滤过(high volume hemofiltration,HVHF)对严重脓毒症合并多器宫功能障碍综合征((multiple organ dysfunction syndrome,MODS)的治疗作用.[方法]选择由各种病因导致的26例严重脓毒症合并MODS患者,每日持续给予床旁HVHF(置换液流量60 ml· (kg.h)-1治疗10～ 18 h,观察治疗前后患者生命体征、血流动力学参数、呼吸参数、肝肾功能指标、动脉血乳酸、前降钙素(Procalcitonin,PCT)的变化,以及APACHEⅡ评分、MODS评分.[结果]患者在接受HVHF治疗后APACHEⅡ评分、MODS评分显著降低,T、HR改善(P＜ 0.05)；HVHF可改善脓毒症合并多器官功能障碍综合征患者血流动力学,治疗后48 h、72h明显好转,MAP、CI、SVI、SVRI趋向稳定,与HVHF前相比差异均有显著性(P＜ 0.05)；HVHF后24、48、72h患者呼吸趋于平稳,氧和改善,PaO2及PaO2/FiO2逐渐升高至正常水平,与HVHF前相比差异具有显著性(P＜0.05)；患者HVHF后肝肾功能好转,趋于正常,动脉血乳酸、PCT均逐渐下降至正常,HVHF后24、48、72 h与HVHF前相比差异具有显著性(P＜0.05).[结论]HVHF可使脓毒症合并MODS患者的生命体征趋于平稳,可改善患者的呼吸及氧和功能、改善血流动力学,改善脏器功能及组织灌注.

Effect of high volume hemofiltration in severe sepsis patients with multiple organ dysfunction syndrome

[Objective] To investigate the effect of high volume hemofihration in sepsis patients with multiple organ dysfunction syndrome （MODS） [ Methods ] Twenty-six adult patients with severe sepsis patients with MODS were given HVHF（60 ml. （kg. h）-l）, lasting 10- 18 hours every day. Observed the patient＇s vital signs, Hemodynamics, Respiratory parameters, Liver and kidney function parameters, Arterial blood lactate, PCT and Acute physiology and chronic health evaluation H （APACHE I1 ） scores, multiple organ dysfunction syndrome （MODS） evaluation scores, before and after treatment [Results] APACHE lI score, MODS score of patients receiving HVHF were significantly lower after treament, T, HR improved （P 〈 0.05）; Hemodynamics of the sepsis patients with multiple organ dysfunction syndrome （MODS） was significantly improved in 48 h, 72 h of treatment; MAP, CI, SVI, SVRI tend to be stable, compared with before HVHF. there were significant differences （P 〈 0.05）; Respiratory, oxygen were improved, PaO2 and PaOJFiO2 gradually increased to normal levels, in 48 h, 72 h of HVHF treatment （P 〈 0.05） ;Liver and kidney function were improved after HVHF; arterial blood lactate, PCT reduced to normal, in 24 h, 48 h, 72 h of HVHF treatment （P 〈 0.05）. [Conclusion] HVHF can merge MODS in sepsis patients with stable vital signs, HVHF shows significant beneficial effects on Breathing and oxygen function of sepsis patients with MODS. HVHF improve hemodynamics, improve organ function and tissue perfusion.