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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。
Objective To investigate the clinical efficacy and prognosis of high-volume hemofiltration (HVHF) in the treatment of severe sepsis and septic shock. Methods Sixteen patients with severe sepsis and septic shock were treated with HVHF. The heart rate (HR), mean arterial pressure (MAP), body temperature (T) and blood pressure were measured before and 12, 24, 48 and 72 h after treatment. PaO2 / FiO2, APACHEⅡscore, SOFA score, pH, serum sodium, serum potassium and blood lactic acid, and observed the clinical effect . Results Of the 16 patients, 10 were markedly effective, 3 were effective and 3 were ineffective (death). Compared with those before treatment, the HR of 13 patients after treatment for 24, 48 and 72 h were significantly lower than those before treatment (APACHE II, SOFA, serum potassium, lactate, 12 h, 24 h, 48 h and 72 h after treatment) (P <0.05 or P <0.01). After 48 and 72 h of treatment, the PaO2 / FiO2 ratio and pH values were significantly increased after treatment for 12, 24, 48 and 72 h (P <0.05 or P <0.01) ). Conclusions Early initiation of HVHF in patients with severe sepsis and septic shock can stabilize hemodynamics and speed up organ function recovery. The outcome depends on the severity of the primary disease and the timing of its initiation.