高流量CVVH治疗严重腹腔感染的疗效探究

摘要

Objective To investigate the clinical efficacy of high flow continuous veno-venous hemofiltration (CVVH) in the treatment of severe intra-abdominal infection.Methods 83 patients with severe intraabdominal infection admitted to intensive care unit (ICU) were recruited into this study.Patients were divided into 3 groups.Patients in high flow CVVH group (n=33) and low flow CVVH group (n=29) received either high flow or low flow CVVH.CVVH was not performed for patients in control group.All patients received comprehensive treatment routinely performed at ICU.Results APACHE Ⅱ score in high flow CVVH group significantly declined ever since 12 h post-treatment (P＜0.05),and significantly lower than those in control group (P＜0.05).Inflammatory factors,including TNF-α,IL-6,and CRP showed a trend of decline after high flow and low flow CVVH treatment.24 h after treatment,the values of above three inflammatory factors in high flow CVVH group were significantly lower than those in control group (P＜0.05).The length of hospitalization in high flow CVVH group was significantly less than that in control group and low flow CVVH group (P＜0.05).Improvement rate in high flow CVVH group was better than that in control group (P＜0.05).Conclusions High flow CVVH can efficiently relieve the symptoms of patients with severe intra-abdominal infection,improve APACHE Ⅱ score and patients' prognosis,which could be related to efficient clearance of multiple inflammation factors by high flow CVVH.%目的 探讨高流量连续性静脉-静脉血液滤过(CVVH)治疗严重腹腔感染患者的疗效.方法 收集严重腹腔感染入住重症监护室的患者83例,在综合治疗的基础上予高流量CVVH(n=33)、低流量CVVH(n=29)治疗,对照组(n=21)仅综合治疗.分别于治疗前及治疗后12、24、48、72小时观察患者的APACHEⅡ评分、炎症因子等的动态变化.并统计患者的预后,包括住院天数、好转率和病死率.结果 高流量CVVH患者的APACHEⅡ评分于治疗后12小时开始明显降低(P＜0.05),且明显低于对照组(P＜ 0.05).治疗后高流量CVVH组和低流量CVVH组的TNF-α、IL-6和CRP值均呈下降趋势.治疗后24小时始,高流量CVVH组的三者炎症因子均明显低于对照组(P＜0.05).高流量CVVH组患者的住院天数明显少于对照组和低流量CVVH组(P＜0.05).高流量CVVH组患者的好转率明显高于对照组(P＜0.05).结论 高流量CVVH能有效缓解严重腹腔感染患者的症状,提高APACHEⅡ评分,并改善患者预后.这些效应可能与高流量CVVH迅速有效清除外周血中多种炎症因子有关.