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目的:探讨连续性血液净化(CRRT)对脓毒症合并多器官功能障碍综合征(MODS)患者血流动力学和炎症介质清除效能的影响。方法:40例脓毒症合并MODS患者为研究对象,随机分为对照组(20例)和CRRT治疗组(20例)。CRRT组给予24 h的CRRT治疗;通过放置Pi CCO导管,监测心排血量(CO)、血管外肺水指数(EVLWI)和胸腔内血容量指数(ITBVI)的变化,记录心率、有创平均动脉压、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及MODS评分结果;用ELISA法检测治疗前后两组患者炎性介质的变化。结果:对照组治疗前后各指标均无明显改善(P均>0.05)。CRRT组治疗24 h后,患者CO明显下降,EVLWI减少,ITBVI趋向稳定,心率(HR)和平均动脉压(MAP)改善,APACHEⅡ评分及MODS评分下降,肿瘤坏死因子α(TNF-α)、白介素(IL)-6、IL-8的血清水平均呈明显的下降趋势。与CRRT治疗前及对照组比较差异均有统计学意义(P均<0.05)。结论 :脓毒症合并MODS患者行CRRT治疗可明显改善患者的血流动力学,清除体内过度释放的炎症因子,有效阻断MODS向MOF发展的进程。
Objective: To investigate the effects of continuous blood purification (CRRT) on hemodynamics and inflammatory mediators in patients with sepsis and multiple organ dysfunction syndrome (MODS). Methods: Forty patients with sepsis and MODS were randomly divided into control group (20 cases) and CRRT group (20 cases). The CRRT group was given CRRT for 24 hours. The changes of cardiac output (CO), extraluminal lung water index (EVLWI) and thoracic blood volume index (ITBVI) were monitored by placing Pi CCO catheter. The heart rate, Arterial pressure, acute physiology and chronic health status score system Ⅱ (APACHE Ⅱ) score and MODS score results. The changes of inflammatory mediators in both groups before and after treatment were detected by ELISA. Results: There was no significant improvement in the control group before and after treatment (P all> 0.05). In the CRRT group, the CO decreased significantly, the EVLWI decreased, the ITBVI tended to be stable, the heart rate (HR) and mean arterial pressure (MAP) improved, the APACHEⅡscore and MODS score decreased, while the levels of tumor necrosis factor-α (IL) -6, IL-8 serum levels showed a significant downward trend. Compared with CRRT before treatment and control group, the differences were statistically significant (all P <0.05). CONCLUSIONS: CRRT treatment in patients with sepsis and MODS can significantly improve hemodynamics, clear excessive release of inflammatory cytokines, and effectively block the progression of MODS to MOF.