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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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

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	LUO Weixiong
	ZHANG Yanfeng
	LUO Weiwen

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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[J]. 河北医学, 2017, 23(5): 708-711.

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

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