年整理连续性血液净化对重症脓毒症患者内皮损伤保护作用的研究.docVIP

连续性血液净化对重症脓毒症患者内皮损伤保护作用的研究 安徽医科大学附属省立医院，安徽省立医院ICU 230001[Abstract] Objective To study protective effect of continue blood purification(CBP) on endothelial damage in patients with severe sepsis, and relationship between endothelial damage and state of an illness. Methods 17 cases with severe sepsis were chosen. von Willebrand factor(vWF), blood clotting parameters, blood routine and biochemic index were determined before treatment and next morning after treatment of CBP. Results To compare with pre-treatment, the concentration of vWF, APACHEⅡ and MODS scores were significantly decreased in the next morning of post-treatment(P0.05). Before treatment of CBP, vWF had a positive correlation with WBC and PLT(P0.01) and a negative correlation with PO2/FiO2(P0.05). After treatment of CBP, it had a positive correlation with WBC and 基金项目：安徽省卫生厅科研计划项目（2002B007） 作者单位：230001合肥，安徽医科大学附属省立医院，安徽省立医院ICU（王锦权、陶晓根、周彩平、 承韶晖、赵劲松、吴双正、叶文），检验中心（张翠萍） D-dimer(P0.01,0.05). However, vWF had a positive correlation with WBC only in the survival group (P0.01), but it had a positive correlation with the amount of dehydration by CBP and Hct(P0.01) and a negative correlation with PT-INR and APTT(P0.01,0.05) in the death group. Conclusion Continue blood purification had protective effect on endothelial damage in patients with severe sepsis. The coagulopathy was due to endothelial damage in the patients with severe sepsis. But during the treatment of CBP, the more dehydration could not lead to the better effect. [Key words] Severe sepsis, Continue blood purification, von Willebrand factor, Endothelial damage 脓毒症和感染性休克是危重病医学所面临的重大难题，疾病的死亡率高达50%以上[1]；在其病理生理过程中，内毒素可直接损伤血管内皮细胞，对疾病的发生、发展起着重要作用[2]。血管性假性血友病因子(von Willebrand factor, vWF)是血管内皮细胞损伤的重要且敏感的指标之一；内皮细胞受损后，vWF分泌增加所引起的凝血与纤溶系统失衡导致的凝血功能障碍在多器官功能障碍综合征（multiple organ dysfunction syndrome，MODS）的发病机制中有重要意义，vWF作为MODS治疗与预后的指标正越来越受到重视[3]。近年来，连续性血液净化（continue blood purification, CBP）被用于重症脓毒症和感染性休克等治疗取得一定的疗效[4]。为了探讨CBP治疗严重脓毒症对血管内皮细胞的影响，我们对17例重症脓毒症患者接受CBP治疗前、后血浆