血液滤过对严重脓毒血症炎症因子与血流动力学的影响

　　【论文摘要】目的：观察探讨血液滤过对严重脓毒血症患者炎症因子与血流动力学的影响。方法：选取本院2013年3月-2014年11月收治的68例严重脓毒症患者，应用抗感染、护肝及补液多种对症治疗，在防治纠正多器官功能障碍的基础上进行血液净化治疗措施。观察脓毒症患者高容量血液滤过前后的APACHEⅡ评分和血流动力学水平变化。结果：严重脓毒症患者滤过前APACHEⅡ评分为（24.55±3.67）分，滤过后APACHEⅡ评分为（17.34±3.22）分，进行血液滤过后APACHEⅡ评分明显降低，比较差异有统计学意义（P<0.05）。患者血液滤过后血清白蛋白显著上升，白细胞及血小板均显著下降，血糖明显升高，血肌酐显著下降，与治疗前比较差异均有统计学意义（P<0.05）。患者血液滤过后MAP、PaO2/FiO2较治疗前显著上升，CVP较治疗前略有下降，以上指标与治疗前比较，差异均有统计学意义（P<0.05）。结论：血液滤过对严重脓毒血症患者器官衰竭及全身炎症反应疗效显著，能明显降低患者血清炎症因子，促进血清电解质平衡，抑制全身炎症反应的进展，可较好的解决毒素及代谢物质堆积的问题，温和缓慢的去除血浆中可溶性炎症介质，抑制机体过分的炎症反应，改善患者全身血流动力学及预后情况。临床选择优势较高，无严重不良反应，值得进一步推广应用。
　　【论文关键词】血液滤过；严重脓毒血症；炎症因子；血流动力学
　　【Abstract】 Objective：To investigate the effect of hemofiltration on inflammatory factors and hemodynamics in patients with severe sepsis.Method：Sixty-eight severe sepsis patients of our hospital from March 2013 to November 2014 were selected as the objects，they recieved lots of symptomatic treatment like anti–infection application，liver protection and rehydration，blood purification treatment was implemented on the basis of the correction of multiple organ dysfunction.The changes of APACHE II score and hemodynamics in patients with sepsis before and after hemofiltration were observed.Result：After the treatment，the APACHE score of patients with severe sepsis before hemofiltration was（24.55±3.67）points，while which was （17.34±3.22）points after hemofiltration，it was significantly decreased and the difference was statistically significant（P<0.05）.The serum albumin was significantly increased，the leukocyt and thrombocyt were significantly decreased，the blood glucose was significantly increased，and the blood creatinine was significantly decreased compared with which before treatment，the differences above were statistically significant（P<0.05）.After hemofiltration in patients with severe sepsis，the two indicators of MAP and PaO2/FiO2 were significantly higher than which before treatment，while the CVP was a slight decreased，the differences were statistically significant（P<0.05）.Conclusion：Hemofiltration has a significant effect on serious sepsis patients with organ failure and systemic inflammation response，it can significantly reduce the serum inflammatory factors，promote the balance of electrolyte in serum，inhibit the progression of systemic inflammatory response，which can better solve the accumulation status of toxins and metabolites，It can removal of plasma，soluble inflammation mediators slowly and gently，inhibit excessive inflammatory reaction，improve patients’ hemodynamics and prognosis.Hemofiltration has high clinical selective advantages，no serious adverse reactions，it is worthy of further application.
　　【Key words】 Hemofiltration； Severe sepsis； Inflammatory factor； Hemodynamics
　　脓毒症是由于患者遭遇严重外伤、感染、烧伤及创伤导致的全身严重炎症反应，患者机体免疫系统代偿水平大幅度下降，毒素及代谢物质的堆积，导致血液粘滞、炎症反应加剧、内环境紊乱、水电解质平衡紊乱，严重者继而发生器官连锁衰竭、过度炎症反应等多种情况，病死率居高不下[1]。文献[2]报道，脓毒症器官功能障碍患者死亡率为74%。临床血液滤过能有效清除大、中分子物质及与蛋白结合的物质，从而达到体内酸碱、电解质平衡，减轻全身炎症反应引起的精神躁狂现象。近年来临床常用血液净化方法治疗严重脓毒症患者，文献[3]报道，若在脓毒症早期积极采取血液滤过治疗往往可以大幅度提升救治率，降低患者死亡风险，保障患者生命安全。本文选取本院2013年

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血液滤过对严重脓毒血症炎症因子与血流动力学的影响