连续性静静脉血液滤过cvvh并强化胰岛素治疗重度-现代临床医学.docVIP

连续性静静脉血液滤过(CVVH)连续性静静脉血液滤过(CVVH)连续性静静脉血液滤过ursing Experience of Continuity of Static Venous Hemofiltration (CVVH) and intensified insulin therapy in severe sepsis WANG Yan ,BAI Aihua ((1.Infection department of Jishuitan Hospital,Beijing,100035,china) [Abstract] Objective To evaluate the continuity venous to venous hemofiltration (CVVH) and improved insulin to control blood sugar in patients with severe sepsis and monitoring point, improve the effect of nursing care. Methods To analyze the clinical features of 77 patients with severe sepsis and nursing characteristics of continuity of venous to venou hemofiltration and improved insulin to control blood sugar treatment Results 41 cases patients blood purification treatment can rapidly improve symptoms, reduce the cycle of the shock. Properly execute insulin intensive treatment, blood glucose monitor on time; Infection control, completes the cool care; Attaches great importance to the hypoglycemia; To keep blood sugar stable tendency in 4.4-6.1mmol/L; It can significantly improve the prognosis. Conclusion Refractory patients with sepsis often mixed with bacteria infection, we must strengthen the blood glucose, sterile nursing and bacteriological monitoring; Timely identification of risk factors of multiple organ failure, maintain vital organ function; Eliminate inflammation medium and toxin in the body, blocking the evolution of shock; Pay attention to psychological nursing. [key words] continuity venous to venous hemofiltration ; Intensive insulin; Severe sepsis; nurse 脓毒血症(Sepsis)是指感染导致的全身炎症反应综合征，是目前重症监护室中死亡的首要原因。治疗如果不及时，病情可恶化发展为重度脓毒症(Severe sepsis)及脓毒性休克(Septic shock)，从而引发多脏器功能不全(MODS)[1]，重度脓毒症的发生与以下因素有关：长期应用广谱抗生素导致耐药菌增多，老年病人免疫功能低下、激素与抗肿瘤药物的应用、各种外科手术和侵袭性操作、营养不良或慢性疾病。重症脓毒症病死率高达28%~50%，其死亡率与发生功能障碍的器官系统的数目与严重程度有关。我们采用连续性静静脉血液滤过12mmol/L才开始应用胰岛素，将血糖水平控制在10.0~11.1mmol/L，当血糖10mmol/L就停用胰岛素；治疗组是指强化胰岛素治疗，将血糖数值严格控制在4.4～6.1 mmol/L之间，按时监测血糖值，每30~60min监测1次，根据血糖值调整胰岛素用量，使血糖值尽快降至4.4-6.1mmol/L[3]。，本实验应用了血糖控制软件，提前发出报警音，指导护士正确执行胰岛素强