实用临床医学
實用臨床醫學
실용림상의학
Practical Clinical Medicine
2014年
5期
1-4
,共4页
孙冰峰%付强%唐元明%张莉%唐漭明%苟峰%柳林%柳建%王丽娜%古宗领%刘敏%葛金凤
孫冰峰%付彊%唐元明%張莉%唐漭明%茍峰%柳林%柳建%王麗娜%古宗領%劉敏%葛金鳳
손빙봉%부강%당원명%장리%당망명%구봉%류림%류건%왕려나%고종령%류민%갈금봉
严重脓毒血症%脓毒性休克%高容量血液滤过%血流动力学%APACHEⅡ评分
嚴重膿毒血癥%膿毒性休剋%高容量血液濾過%血流動力學%APACHEⅡ評分
엄중농독혈증%농독성휴극%고용량혈액려과%혈류동역학%APACHEⅡ평분
severe sepsis%sepsis shock%high volume hemofiltration%hemodynamics%APACHEⅡscore
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（APACHE Ⅱ）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。
目的：探討高容量血液濾過（HVHF）治療嚴重膿毒血癥及膿毒性休剋的臨床療效及預後。方法對16例嚴重膿毒血癥及膿毒性休剋患者行HVHF治療，併比較治療前，治療後12、24、48和72 h心率（HR）、平均動脈壓（MAP）、體溫（T）、氧閤指數（PaO2/FiO2）和急性生理與慢性健康狀況（APACHE Ⅱ）評分、序貫器官衰竭估計（SOFA）評分及pH、血鈉、血鉀和血乳痠的變化情況，同時觀察臨床療效的情況。結果16例患者中，顯效10例，有效3例，無效（死亡）3例。與治療前比較，13例患者治療24、48和72 h後HR值，治療12、24、48和72 h後APACHEⅡ、SOFA得分、血鉀、乳痠值，治療24、72 h後血鈉值均明顯降低（P＜0.05或P＜0.01），治療48、72 h後MAP值，治療12、24、48和72 h後 PaO2/FiO2比值、pH值均明顯升高（P＜0.05或P＜0.01）。結論早期啟動HVHF治療嚴重膿毒血癥及膿毒性休剋患者可以穩定血流動力學，加快機體髒器功能恢複，其轉歸取決于原髮病本身的嚴重程度及啟動時機。
목적：탐토고용량혈액려과（HVHF）치료엄중농독혈증급농독성휴극적림상료효급예후。방법대16례엄중농독혈증급농독성휴극환자행HVHF치료，병비교치료전，치료후12、24、48화72 h심솔（HR）、평균동맥압（MAP）、체온（T）、양합지수（PaO2/FiO2）화급성생리여만성건강상황（APACHE Ⅱ）평분、서관기관쇠갈고계（SOFA）평분급pH、혈납、혈갑화혈유산적변화정황，동시관찰림상료효적정황。결과16례환자중，현효10례，유효3례，무효（사망）3례。여치료전비교，13례환자치료24、48화72 h후HR치，치료12、24、48화72 h후APACHEⅡ、SOFA득분、혈갑、유산치，치료24、72 h후혈납치균명현강저（P＜0.05혹P＜0.01），치료48、72 h후MAP치，치료12、24、48화72 h후 PaO2/FiO2비치、pH치균명현승고（P＜0.05혹P＜0.01）。결론조기계동HVHF치료엄중농독혈증급농독성휴극환자가이은정혈류동역학，가쾌궤체장기공능회복，기전귀취결우원발병본신적엄중정도급계동시궤。
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 measu-red 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, 48 and 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 and 72 hours after treatment significantly decreased,but MAP determined 48 and 72 hours after treatment and PaO2/FiO2 ratio 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.
