【摘要】 目的探讨高容量血液滤过(HVHF)治疗严重脓毒血症及脓毒性休克的临床疗效及预后。方法对16例严重脓毒血症及脓毒性休克患者行HVHF治疗,并比较治疗前,治疗后12、24、48和72 h心率(HR)、平均动脉压(MAP)、体温(T)、氧合指数(PaO2/FiO2)和急性生理与慢性健康状况(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分及pH、血钠、血钾和血乳酸的变化情况,同时观察临床疗效的情况。结果 16例患者中,显效10例,有效3例,无效(死亡)3例。与治疗前比较,13例患者治疗24、48和72 h后HR值,治疗12、24、48和72 h后APACHEⅡ、SOFA得分、血钾、乳酸值,治疗24、72 h后血钠值均明显降低(P<0.05或P<0.01),治疗48、72 h后MAP值,治疗12、24、48和72 h后PaO2/FiO2比值、pH值均明显升高(P<0.05或P<0.01)。结论早期启动HVHF治疗严重脓毒血症及脓毒性休克患者可以稳定血流动力学,加快机体脏器功能恢复,其转归取决于原发病本身的严重程度及启动时机。更多还原

【Abstract】 Objective To discuss the curative effects of high volume hemofiltration(HVHF)on severe sepsis and sepsis shock. Methods Sixteen patients with severe sepsis and sepsis shock were treated with HVHF. Heart rate(HR),mean arterial pressure(MAP),temperature(T),oxygenation index(PaO2/FiO2),Acute Physiology and Chronic Health Evaluation(APACHEⅡ)score,Sepsis-related Organ Failure Assessment(SOFA)score,pH and blood levels of sodium,potassium and lactic acid were measured before and 12, 24, 48 and 72 hours after treatment. In addition, clinical efficacy was observed in all patients. Results Among the 16 patients,the treatment was markedly effective in 10,effective in 3, and ineffective(died) in 3. Compared with parameters determined before treatment, HR determined 24, 48and 72 hours after treatment, APACHEⅡ score, SOFA score and blood levels of potassium and lactic acid determined 12, 24, 48 and 72 hours after treatment and blood levels of sodium determined 24 and72 hours after treatment significantly decreased,but MAP determined 48 and 72 hours after treatment and PaO2/FiO2ratio and pH determined 12,24,48 and 72 hours after treatment significantly increased in 13 patients(P<0.05 or P<0.01).Conclusion Early treatment with HVHF can stabilize hemodynamics and accelerate the recovery of organ functions in patients with severe sepsis and sepsis shock. The clinical outcome depends on the severity of protopathy and timing of HVHF initiation.更多还原