摘要
目的 分析连续性静-静脉血液滤过（CVVH）对感染性休克合并急性肾损伤（AKI）患者血流动力学的影响.方法 对行CVVH治疗的感染性休克合并AKI患者的临床资料作一回顾性分析.使用PICCO监测仪对实施CVVH治疗的患者进行血流动力学监测,每例患者分别在暂停CVVH期间及治疗时进行检测,并记录所测数据,同时记录HR、有创平均动脉压（MAP）、氧合指数（PaO2/FiO2）及去甲肾上腺素维持剂量等变化.结果 暂停CVVH期间及治疗时心脏指数的平均值分别为（4.73±0.87）和（4.67±0.85）L·min-1·m-2,全心舒张末期容积指数的平均值分别为（780.60±110.13）和（783.55±113.28） ml/m2,血管外肺水指数的平均值分别为（10.97±3.35）和（10.84±3.54）ml/kg,两者上述指标的差异均无统计学意义（均P ＞0.05）.治疗后MAP及PaO2/FiO2均较治疗前明显增高,HR、去甲肾上腺素维持剂量均较治疗前明显降低（P＜0.05或0.01）.结论 CVVH不影响感染性休克合并AKI患者的血流动力学的稳定性和采用PICCO监测的准确性、可靠性,并可能对患者预后有改善作用.
Objective To investigate the impact of continuous veno-venous hemofiltration on hemodynamics in patients with septic shock complicated by acute kidney injury. Methods Medical records of patients with septic shock complicated by acute kidney injury were retrospectively reviewed. Hemodynamic monitoring was performed by using PiCCO system. The measurement was performed during and between CRRT sessions. Heart rate, mean arterial pressure, oxygenation index and dose of dobamine were recorded. Results During and between CRRT sessions, the cardiac indices were （4.73 ± 0.87）L-min-1.m-2 and （4.67 ± 0.85）L,min-1,m-2, respectively; the global end diastolic volume indices were 780.60 ± 110.13 and 783.55 ± 113.28 ml/m2, respectively; the extravascular lung water indices were （10.97 ± 3.35） and （10.84 ± 3.54）ml/kg, respectively. There was no significant difference in any parameters measured during and between CRRT sessions （P〉0.05）. MAP and PaO2/FiO2 were markedly improved after treatment, while HR and the dose of dobamine were reduced after treatment （P〈0.05 or 0.01）. Conclusion CVVH has no impact on hemodynamic stability and the accuracy of PiCCO monitoring in patients with septic shock complicated by acute kidney injury, but might have beneficial effect on patient＇s outcome.
出处
《浙江医学》
CAS
2012年第2期82-83,90,共3页
Zhejiang Medical Journal
