连续性静脉-静脉血液滤过联合血液灌流对严重脓毒症患者腹腔内压的影响

doi:10.3969/j.issn.1006-6233.2017.05.002

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摘要 目的: 探讨连续性静脉-静脉血液滤过(CVVH)联合血液灌流(HP)治疗对严重脓毒症患者腹腔内压的影响。方法: 采用前瞻性研究方法,选取我院重症医学科2011年12月至2014年8月收治的60例严重脓毒症患者为研究对象,所有患者在抗感染、限制性液体复苏、胃肠减压、灌肠导泻、抑制胃酸、镇静镇痛、营养支持和维持电解质、酸碱平衡等常规性治疗的基础上给予CVVH联合HP治疗5d。比较患者治疗前及治疗后12h、1d、3d、5d后的腹内压(IAP)、C-反应蛋白(CRP)、降钙素原(PCT)、平均动脉压(MAP)、血乳酸(Lac)、血肌酐(Scr)、氧合指数(OI)、急性生理与慢性健康评分Ⅱ(APACHE-Ⅱ评分)及全身性感染相关性器官功能衰竭评分(SOFA评分)的变化。结果: CVVH联合HP治疗12h后患者PCT、Scr开始下降,与治疗前比较差异有统计学意义(P<0.05),治疗1d后IAP、CRP、PCT、Lac、Scr、APACHEⅡ评分、SOFA评分均有下降,MAP、OI开始上升,与治疗前相比差异均有统计学意义(P<0.05)。IAP、CRP、Lac、Scr、APACHEⅡ评分治疗后逐日下降,于治疗后5d降至最低,PCT与SOFA评分治疗后逐日降低,在治疗3d时降至最低,第5天时稍有上升。MAP与OI治疗后逐日上升,治疗后5d达到最高数值。结论: CVVH联合HP治疗对严重脓毒症患者合并IAH可有效降低腹内压,改善病情。

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	罗伟雄
	张彦峰
	罗伟文

关键词 ：严重脓毒症, 腹腔高压, 连续性静脉‐静脉血液滤过, 血液灌流

Abstract：Objective: To investigate the effect on intra-abdominal pressure by continuous veno-venous hemofiltration(CVVH) combined with hemoperfusion(HP) in patients with severe sepsis. Methods: 60 cases of patients with severe sepsis were enrolled in the research from ICU of our hospital from December 2011 to August 2014 with the prospective study method. All of the patients were treated by anti-infection, restrictive liquid recovery, gastrointestinal decompression, enema catharsis, inhibition of gastric acid, sedation and analgesia, nutritional support and maintenance of electrolyte and acid-base balance. CVVH combined with HP were applied in this research for five days on the above basis of routine treatment. The changes of intra-abdominal pressure (IAP), C-reactive protein (CRP), procalcitonin(PCT), mean arterial pressure (MAP), lactic acid (Lac), serum creatinine (Scr), oxygenation index (PaO₂ /FiO₂ ), acute physiology and chronic health evaluation Ⅱ (APACHE - Ⅱ score) and sepsis-related organ failure assessment (S0FA) were compared before treatment and after treatment in patients with 12h, 1d, 3d, 5d. Results: CVVH combined with HP treatment of 12h patients with PCT, Scr began to decline, compared with before treatment, the difference was statistically significant (P<0.05). IAP, CRP, PCT, Lac, Scr, APACHE Ⅱ score and SOFA score were all falling after 1d treatment. MAP and OI began to rise and the differences were statistically significant compared with before treatment. IAP, CRP, Lac, Scr, APACHE Ⅱ scores declined daily after treatment and declined to the lowest after 5d treatment. PCT and SOFA score reduced day by day after treatment and fell to the lowest after 3d treatment. They increased slightly in the fifth day. MAP and OI increased after treatment, the highest value reached 5D after treatment. Conclusion: CVVH with HP therapy can effectively reduce the internal pressure and improve the condition for patients with severe sepsis and intra-abdominal hypertension.

Key words： Severe sepsisl Intra-abdominal hypertension Continuous veno-venous hemofiltration Hemoperfusion

基金资助:广东省科技计划项目,(编号:20110311)

引用本文:

罗伟雄, 张彦峰, 罗伟文. 连续性静脉-静脉血液滤过联合血液灌流对严重脓毒症患者腹腔内压的影响[J]. 河北医学, 2017, 23(5): 708-711.
LUO Weixiong, ZHANG Yanfeng, LUO Weiwen. The Effect on Intra-abdominal Pressure by Continuous Veno-venous Hemofiltration Combined with Hemoperfusion in Patients with Severe Sepsis. 河北医学, 2017, 23(5): 708-711.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2017.05.002 或 http://www.hbyxzzs.cn/CN/Y2017/V23/I5/708

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