连续性血液净化对合并心肌损伤的感染性休克患者心功能及组织灌注的影响.docVIP

连续性血液净化对合并心肌损伤的感染性休克患者心功能及组织灌注的影响 Effects of continuous blood purification on cardiac function and tissue perfusion in patients with septic shock complicated myocardial injury 张伟，陈微微 王远方 李建萍 (遵义市第一人民医院 重症医学科 贵州遵义 563002) 遵义市联合基金 遵市科合社字2012（13） 摘要 目的 观察连续性血液净化 ( CBP)对合并心肌损伤的感染性休克患者心功能及组织灌注的影响。方法 选择40例合并心肌损伤的感染性休克患者行连续性静脉静脉血液滤过治疗，治疗期间用PiCCO监测记录血管外肺水指数（EVLWI）肺血管通透指数（PVPI）及反映心功能的指标脑利钠肽、肌钙蛋白I与组织灌注指标水平的变化。结果 随着治疗时程的延长，患者血管外肺水指数与肺血管通透指数指数明显下降(P 0 .01)，心功能指标脑利钠肽及肌钙蛋白I有明显下降(P 0 .01)，组织灌注的指标血乳酸(Lac)、 中心静脉血氧饱和度（ScVO2）、动静脉二氧化碳分压差（P（cv-a）CO2)有明显下降(P 0 .01)。结论 CBP可改善合并心肌损伤的感染性休克患者心功能及组织灌注水平。 关键词 连续性血液净化(CBP);感染性休克; 脑利钠肽(BNP)；肌钙蛋白I(cTnI)；血乳酸(Lac)； 中心静脉血氧饱和度（ScVO2）；动静脉二氧化碳分压差（P（cv-a）CO2 )、血管外肺水指数( EVLWI) ,肺毛细血管通透指数( PVPI)。 Abstract：Objective To observe the effects of CBP on cardiac function and tissue perfusion in patients with septic shock complicated myocardial injury. Method 40 patients merged myocardial injury with septic shock were treated with CVVH. EVLWI and PVPI were measured or calculated at scheduled intervals using PiCCO, and at the same time recorded the changes of the parameters of reflection of cardiac function that BNP, cTnI as well as tissue perfusion level. Results With the extension of the schedule, EVLWI and PVPI of the patients decreased obviously (P 0. 01), the level of BNP and cTnI had significantly lower (P 0. 01), the parameter of tissue perfusion that Lac, ScVO2, P (CV - a) CO2 had significantly lower (P 0. 01). Conclusion Cardiac function and tissue perfusion of the patients merged myocardial injury with septic shock can benefit from the treatment of CBP. Key words: Continuous blood purification; Septic shock; Brain natriuretic peptide (BNP); Troponin I (cTnI); Blood lactic acid (Lac); Central venous blood oxygen saturation (ScVO2); Arteriovenous CO2 partial pressure differential (P (CV - a) CO2),Extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI). 严重感染及感染性休克是多器官功能障碍综合征(MODS)的主要