CAJ | 학술논문

目的探讨连续性高容量血液滤过(HVHF)和连续性静脉-静脉滤过透析(CVVHDF)两种模式对脓毒症的治疗效果.方法 51例脓毒症患者随机分为两组,HVHF组27例,CVVHDF组24例.HVHF组置换液量4L/h; CVVHDF组置换液量2 L/h,透析液量2L/h.于治疗前和治疗后24小时测定血清白细胞介素(IL)-6浓度,治疗后测定超滤液中IL-6浓度.同时观察两组患者治疗前后体温、心率(HR)、平均动脉压(MAP)、氧合指数(PaO2/FiO2)、尿素氮(BUN)、肌酐(Cr)的变化.结果治疗后HVHF组及CVVHDF组血清IL-6浓度较治疗前均明显降低,HVHF组(98.97±38.45) ng/L vs(161.84±50.03)ng/L(P＜0.01)；CVVHDF组(125.53±41.44) ng/L vs(143.77±41.28) ng/L(P＜0.05),HVHF组血清IL-6浓度降低较CVVHDF组更显著(P＜0.01)；两组超滤液中均检测到IL-6.两组治疗后较治疗前体温、BUN及SCr均明显下降(P＜0.01),但组间比较差异无统计学意义.两组治疗后较治疗前PaO2/FiO2明显升高,HVHF组:253.67±55.92 vs 173.52±44.59(P＜0.01)；CVVHDF组:208.17±42.37 vs 178.38±36.25( P＜0.01),HVHF组较CVVHDF组氧合改善更明显(P＜0.01).两组治疗前后、两组之间HR、MAP水平差异无统计学意义.结论 HVHF、CVVHDF两种模式均能清除炎性介质,HVHF清除效果优于CVVHDF.HVHF较CVVHDF更能降低机体基础代谢率,增加机体组织的氧供,改善脓毒症患者脏器功能的指标.
목적 탐토련속성고용량혈액려과(HVHF)화련속성정맥-정맥려과투석(CVVHDF)량충모식대농독증적치료효과.방법 51례농독증환자수궤분위량조,HVHF조27례,CVVHDF조24례.HVHF조치환액량4L/h; CVVHDF조치환액량2 L/h,투석액량2L/h.우치료전화치료후24소시측정혈청백세포개소(IL)-6농도,치료후측정초려액중IL-6농도.동시관찰량조환자치료전후체온、심솔(HR)、평균동맥압(MAP)、양합지수(PaO2/FiO2)、뇨소담(BUN)、기항(Cr)적변화.결과 치료후HVHF조급CVVHDF조혈청IL-6농도교치료전균명현강저,HVHF조(98.97±38.45) ng/L vs(161.84±50.03)ng/L(P＜0.01)；CVVHDF조(125.53±41.44) ng/L vs(143.77±41.28) ng/L(P＜0.05),HVHF조혈청IL-6농도강저교CVVHDF조경현저(P＜0.01)；량조초려액중균검측도IL-6.량조치료후교치료전체온、BUN급SCr균명현하강(P＜0.01),단조간비교차이무통계학의의.량조치료후교치료전PaO2/FiO2명현승고,HVHF조:253.67±55.92 vs 173.52±44.59(P＜0.01)；CVVHDF조:208.17±42.37 vs 178.38±36.25( P＜0.01),HVHF조교CVVHDF조양합개선경명현(P＜0.01).량조치료전후、량조지간HR、MAP수평차이무통계학의의.결론 HVHF、CVVHDF량충모식균능청제염성개질,HVHF청제효과우우CVVHDF.HVHF교CVVHDF경능강저궤체기출대사솔,증가궤체조직적양공,개선농독증환자장기공능적지표.