摘要
目的:探讨连续性静脉血液滤过(CVVH)联合血必净治疗重症脓毒症的效果及其对凝血纤溶系统与微循环的影响。方法:选取160例重症脓毒症患者为研究对象,依据治疗方法不同分为CVVH组和联合组,每组各80例。CVVH组患者采用CVVH治疗;联合组患者采用血必净联合CVVH治疗,疗程均为1周。比较两组患者治疗效果、临床体征指标[心率(HR)、动脉血二氧化碳分压(PaCO_(2))和平均动脉压(MAP)]、凝血纤溶指标[凝血酶时间(TT)、纤溶酶α2纤溶酶抑制剂复合物(PIC)和凝血酶-抗凝血酶Ⅲ复合物(TAT)水平]、微循环指标[中心静脉血氧饱和度(ScvO_(2))、乳酸(LAC)水平、毛细血管再充盈时间(CRT)]、炎症指标[白细胞计数(WBC)、C反应蛋白(CRP)水平、降钙素原(PCT)水平]、不良反应及28 d死亡情况。结果:联合组患者治疗有效率高于CVVH组(92.50%vs.81.25%,P<0.05)。治疗24 h内,两组患者HR均逐渐降低(P<0.05),且联合组低于CVVH组(P<0.05);PaCO_(2)和平均动脉压逐渐升高(P<0.05),且联合组高于CVVH组(P<0.05)。治疗结束后,两组患者TT、ScvO_(2)水平均升高(P<0.05),且联合组高于CVVH组(P<0.05);PIC、TAT、LAC、CRT、CRP、WBC和PCT水平均降低(P<0.05),且联合组低于CVVH组(P<0.05)。两组患者不良反应总发生率比较,差异无统计学意义(P>0.05)。联合组患者28 d死亡率低于CVVH组(P<0.05)。结论:血必净与CVVH联合治疗重症脓毒症效果好,可改善患者凝血纤溶系统和微循环功能,降低炎症反应与28 d死亡率,且不良反应少。
Objective:To explore the application effect of continuous veno-venous hemofiltration(CVVH)combined with Xuebijing in the treatment of severe sepsis and its influence on coagulation and fibrinolysis system and microcirculation indicators.Methods:160 patients with severe sepsis were included in the study.They were classified into CVVH group and combined group according to the different treatment methods,with 80 cases in each group.CVVH group was treated with CVVH,and combined group was given Xuebijing combined with CVVH,with continuous treatment for 1 week for evaluation.The therapeutic efficacy,clinical signs[heart rate(HR),arterial carbon dioxide partial pressure(PaCO_(2)),and mean arterial pressure(MAP)],coagulation and fibrinolysis indicators[thrombin time(TT),plasmin alpha 2 plasmin inhibitor complex(PIC),and thrombin-AT III complex(TAT)levels],microcirculation indicators[central venous oxygen saturation(ScvO_(2)),blood lactic acid(LAC)levels,capillary refilling time(CRT)],inflammation indicators[white blood cell count(WBC),C-reactive protein(CRP)levels,procalcitonin(PCT)levels],adverse reactions and 28-day mortality were compared between two groups of patients.Results:The total effective rate of treatment in combined group was higher than that in CVVH group(92.50%vs.81.25%,P<0.05).Within the 24 h of treatment,HR in the two groups was decreased gradually(P<0.05),and the combined group was lower than the CVVH group(P<0.05).PaCO_(2)and MAP were gradually increased,and the combined group was higher than the CVVH group(P<0.05).The TT and ScvO_(2)in the two groups after treatment was risen(P<0.05),and the combined group was higher than the CVVH group(P<0.05).The PIC,TAT,LAC,CRT,CRP,WBC and PCT were declined(P<0.05),and the combined group was lower than the CVVH group(P<0.05).During treatment,there were no obvious differences in adverse reactions between both groups(P>0.05).The 28-day mortality rate with in combined group was lower than that in CVVH group(P<0.05).Conclusion:Xuebijing combined with CVVH has a significant effect in treating severe sepsis.It can effectively improve the coagulation and fibrinolysis system and microcirculation function,and reduce the inflammatory response and 28-day mortality,and it has few adverse reactions.
作者
刘凡
黄金剑
陈京霞
LIU Fan;HUANG Jin-jian;CHEN Jing-xia(Department of Emergency,Affiliated Hospital of Weifang Medical College,Weifang 261000;Department of Critical Care Medicine,Jiaozhou Center Hospital of Qingdao,Qingdao 266300,Shandong,China)
出处
《川北医学院学报》
CAS
2024年第8期1093-1097,共5页
Journal of North Sichuan Medical College
基金
山东省中医药科技发展计划项目(2019-0428)。
关键词
重症脓毒症
血必净
连续性静脉血液滤过
疗效
Severe sepsis
Xuebijing
Continuous veno-venous hemofiltration
Efficacy
