早期连续血液滤过对脓毒性休克肺循环通透性影响.docVIP

早期连续血液滤过对脓毒性休克肺循环通透性影响 　　【摘要】目的 探讨早期连续血液滤过（continuous veno-venous hemofiltration， CVVH）对脓毒性休克肺循环通透性的影响。方法 选取浙江省立同德医院重症医学科2010年6月至2011年12月确诊脓毒性休克患者51例，随机（随机数字法）分为：常规治疗组（A组，27例），CVVH治疗组（B组，24例），B组在A组的治疗基础上完成72 h CVVH，比较两组治疗前后气道平台压（Pplat）、肺顺应性（Cst）、氧合指数（PaO2/FiO2）、血管外肺水指数（extravascular lung water index， EVLWI）及E-选择素的变化。结果 ①治疗后两组患者Pplat均呈下降趋势，在48、72 h同时间点比较B组低于A组（t=2.215，P2/FiO2均呈上升趋势，48、72 h B组高于A组（t=2.732，P0.05）。④治疗后两组患者E-选择素均呈下降趋势， 48、72 h同时间点B组低于A组（t=2.154，P 　　【关键词】血液滤过；脓毒性休克；肺循环；通透性 　　Effect of the application of continuous cenous venous hemofiltration on pulmonary vascular permeability in the early stage of septic shock HU Ma-hong*， ZHANG Geng， XU Xiu-juan， MENG Jian-biao， LI Yu-hua， JI Chun-lian， FANG Qiang.* Intensive Care Unit，First Affiliated Hospital of Medical College， Zhejiang University， Hangzhou 310009， China 　　Corresponding author： FANG Qiang， Email： hmh_mail@163.com 　　【Abstract】Objective To investigate the effect of continuous veno-venous hemofiltration （CVVH） on pulmonary vascular permeability in the early stage of septic shock . Methods Fifty-one patients of septic shock admitted in intensive care unit of the First Affiliated Hopsital of Medical College， Zhejiang University between June 2010 and December 2011 were randomized into two groups by simple random method. Routine treatment was carried out to patients in group A， and routine treatment plus CVVH to patients in group B in the first 72 hours. Repeated respiratory mechanic hemodynamic measurements were done at baseline（Tb） before treatment， at 48 hours （T48）and 72 hours （T72）after the treatment.Pulmonary compliance（Cst）， platform pressure（Pplat）， oxygenation index（PaO2/FiO2）， extravascular lung water index（EVLWI） and E-selectin determined at each time point were recorded in two groups. Results （1） Pplat were decreased significantly after treatment in two groups， and the Pplat in group B were all lower than those in group A at T48 and T72 （t=2.215，P2/FiO2 increased significantly after treatmen