连续性血液净化对重症脓毒症患者内皮损伤保护作用地研究的.docVIP

实用标准文案 精彩文档 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 王锦权 陶晓根 张翠萍 周彩平 承韶晖 赵劲松 吴双正 叶文 高玉华 [摘要] 目的 研究连续性血液净化（CBP）治疗重症脓毒症患者，对血管内皮损伤的保护作用，及内皮损伤与病情演变之间的关系。方法 17例重症脓毒症患者接受CBP治疗25次，观察患者接受CBP治疗前、治疗结束后次日血管性假性血友病因子(vWF)、凝血象、血常规及生化指标等变化。结果 患者接受CBP治疗后，vWF较治疗前降低（P0.05），APACHEⅡ和MODS评分也较治疗前明显降低（P0.05）；CBP治疗前vWF与血WBC及PLT正相关（P0.01），与氧合指数呈负相关（P0.05）；CBP治疗后，vWF与WBC正相关（P0.01），与D-二聚体也呈正相关（P0.05）。存活组CBP治疗后，vWF仅仅与血WBC正相关（P0.01）。死亡组CBP治疗后，vWF与总脱水量及Hct正相关（P0.01），而与PT-INR和APTT负相关（P0.01, 0.05）。结论 CBP治疗对重症脓毒症患者血管内皮损伤起到保护作用，血管内皮损伤可以引起凝血功能紊乱；在CBP治疗过程中，脱水并非越多越好。 [关键词] 重症脓毒症；连续性血液净化；血管性假性血友病因子；内皮损伤 Study of protective effect of continue blood purification on endothelial damage in patients with severe sepsis WANG Jin-quan, TAO Xiao-gen, ZHANG Cui-ping, ZHOU Cai-ping, CHENG Shao-hui, ZHAO Jing-song, WU Shuang-zheng, YE Wen. ICU, Anhui Provincial Hospital, Hefei 230001, China [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