CAJ | 학술논문

目的探讨早期连续血液滤过(continuous veno-venous hemofiltration,CVVH)对脓毒性休克肺循环通透性的影响.方法选取浙江省立同德医院重症医学科2010年6月至2011年12月确诊脓毒性休克患者51例,随机(随机数字法)分为:常规治疗组(A组,27例),CVVH治疗组(B组,24例),B组在A组的治疗基础上完成72 h CVVH,比较两组治疗前后气道平台压(Pplat)、肺顺应性(Cst)、氧合指数(PaO2/FiO2)、血管外肺水指数(extravascular lung water index,EVLWI)及E-选择素的变化.结果 ①治疗后两组患者Pplat均呈下降趋势,在48、72 h同时间点比较B组低于A组(t =2.215,P＜0.05;t=4.266,P＜0.01)；Cst在治疗后呈上升趋势,48、72 h比较B组高于A组(=2.516,P＜0.05;=3.052,P＜0.01).②治疗后两组患者PaO2/FiO2均呈上升趋势,48、72hB组高于A组(t=2.732,P＜0.01; =3.511,P＜0.01).③治疗后两组患者EVLWI均呈下降趋势,48、72 h同时间点B组低于A组(t=2.597,P＜0.05;t =2.125,P＜0.05).治疗后ITBVI、CI、SVRI及MAP组间比较差异无统计学意义(P＞0.05).④治疗后两组患者E-选择素均呈下降趋势,48、72 h同时间点B组低于A组(t=2.154,P＜0.05;t =3.581,P＜0.01).结论早期CVVH治疗能改善脓毒性休克患者的肺血管通透性,减少EVLWI,改善肺氧合功能和肺顺应性,对血流动力学无影响.
목적 탐토조기련속혈액려과(continuous veno-venous hemofiltration,CVVH)대농독성휴극폐순배통투성적영향.방법 선취절강성립동덕의원중증의학과2010년6월지2011년12월학진농독성휴극환자51례,수궤(수궤수자법)분위:상규치료조(A조,27례),CVVH치료조(B조,24례),B조재A조적치료기출상완성72 h CVVH,비교량조치료전후기도평태압(Pplat)、폐순응성(Cst)、양합지수(PaO2/FiO2)、혈관외폐수지수(extravascular lung water index,EVLWI)급E-선택소적변화.결과 ①치료후량조환자Pplat균정하강추세,재48、72 h동시간점비교B조저우A조(t =2.215,P＜0.05;t=4.266,P＜0.01)；Cst재치료후정상승추세,48、72 h비교B조고우A조(=2.516,P＜0.05;=3.052,P＜0.01).②치료후량조환자PaO2/FiO2균정상승추세,48、72hB조고우A조(t=2.732,P＜0.01; =3.511,P＜0.01).③치료후량조환자EVLWI균정하강추세,48、72 h동시간점B조저우A조(t=2.597,P＜0.05;t =2.125,P＜0.05).치료후ITBVI、CI、SVRI급MAP조간비교차이무통계학의의(P＞0.05).④치료후량조환자E-선택소균정하강추세,48、72 h동시간점B조저우A조(t=2.154,P＜0.05;t =3.581,P＜0.01).결론 조기CVVH치료능개선농독성휴극환자적폐혈관통투성,감소EVLWI,개선폐양합공능화폐순응성,대혈류동역학무영향.
Objective To investigate the effect of continuous veno-venous hemofiltration (CVVH) on pulmonary vascular permeability in the early stage of septic shock.Methods Fifty-one patients of septic shock admitted in intensive care unit of the First Affiliated Hopsital of Medical College,Zhejiang University between June 2010 and December 2011 were randomized into two groups by simple random method.Routine treatment was carried out to patients in group A,and routine treatment plus CVVH to patients in group B in the first 72 hours.Repeated respiratory mechanic hemodynamic measurements were done at baseline (Tb) before treatment,at 48 hours (T48) and 72 hours (T72) after the treatment.Pulmonary compliance (Cst),platform pressure (Pplat),oxygenation index (PaO2/FiO2),extravascular lung water index (EVLWI) and E-selectin determined at each time point were recorded in two groups.Results (1) Pplat were decreased significantly after treatment in two groups,and the Pplat in group B were all lower than those in group A at T48 and T72 (t =2.215,P ＜ 0.05 ; t =4.266,P ＜ 0.01).Cst were elevated after treatment in two groups,and Cst in group B were all higher than those in group A at T48 and T72 (t =2.516,P ＜0.05 ; t =3.052,P ＜ 0.01).(2) Compared to before treatment,PaO2/FiO2 increased significantly after treatment in two groups,and PaO2/FiO2 in group B were all higher than those in group A at T48 and T72 (t =2.732,P ＜0.01 ; t =3.511,P ＜0.01).(3) EVLWI were decreased significantly after treatment in two groups,and the EVLWI in group B were all lower than those in group A at T48 and T72 (t =2.597,P ＜0.05; t =2.125,P ＜ 0.05).ITBVI,CI,SVRI and MAP did not change over time in two groups compared with those at Tb (all P ＞ 0.05).(4) E-selectin were decreased significantly after treatment in two groups,and the E-selectin in group B were all lower than those in group A at T48 and T72 (t =2.154,P ＜0.05 ; t =3.581,P ＜ 0.01).Conclusion CVVH in early stage of septic shock can improve pulmonary vascular permeability and oxygenation,increase Cst,and decline EVLWI,with neither increased hemodynamics.