【摘要】目的 评价采用中性树脂的直接血液灌流 (NS-DHP) 治疗革兰氏阴性杆菌脓毒血症的临床疗效及安全性。方法 广州市第一人民医院重症医学科2008年至2010年革兰氏阴性杆菌脓毒血症42例，随机(随机数字法)分为治疗组(D组)18例和对照组(C组)24例。两组患者均予脓毒症集束化治疗，D组在确诊后即行NS-DHP治疗。采用Baxter床旁连续性血液净化机，使用HA330血液灌流器治疗，使用低分子肝素抗凝，血液灌流每次治疗2.5 h，每隔24 h治疗1次，连续治疗3次。两组患者分别于治疗前及治疗24、48、72 h时点监测APACHEⅡ评分、氧合指数(OI)、平均动脉压(MAP)、多巴胺用量(DA)，静脉采血监测血浆内毒素水平(ET)、血清TNF-α水平、IL-6水平、IL-10水平和C反应蛋白水平(CRP)，并比较两组患者28 d病死率及ICU停留时间。结果 D组患者均能耐受血液灌流治疗，无不良并发症发生。两组患者均未接受连续性肾替代治疗。与治疗前比较，两组在治疗24、48、72 h时点，其APACHEⅡ评分、DA、CRP、ET、TNF-α及IL-6水平均有显著下降(P, http://www.100md.com
【关键词】血液灌流；脓毒症休克；炎症介质；APCHEⅡ评分；内毒素
The effect of direct hemoperfusion with neutral resin on patients with septic shock caused by gram-negative bacteria infection SU Wei, YANG Zhi, XU Dong-lin, YANG Zi-li. Department of Intensive Care Unit, First Municipal People’ s Hospital of Guangzhou，Guangzhou 510180，China
Corresponding author: YANG Zi-li, Email:yangzili8888@163.com
【Abstract】Objective To evaluate clinical effect and safety of direct hemoperfusion with neutral resin (NS-DHP) on patients with septic shock caused by Gram-negative bacteria infection. Methods A total of 42 patients were enrolled in the study and randomly (random number)divided into two groups. Patients of control group (n=24) received sepsis bundle therapy, and patients of group D (n=18) were treated with NS-DHP in addition to sepsis bundle therapy. HA330 hemoperfusion device were used in each patient of group D. The procedure of hemoperfusion lasted 2.5 hours and carried out trice a 24 hours. Clinical data including APCHEⅡ score, PO2/FiO2 (OI), mean arterial pressure (MAP), dopamine usage (DA), plasma level of endotoxin (ET), C-reactive protein (CRP), TNF-α, IL-6 and IL-10 were recorded during the treatment. Results Patients well tolerated NS-DHP without any complication in group D. All patients in both two groups did not receive long-term renal replacement therapy. At 24 h, 48 h and 72 h after the initiation of treatment，APACHEⅡ score, OI, MAP, DA, ET, CRP, TNF-α and IL-6 improved obviously both groups (P2/FiO2 and MAP in patients with septic shock caused by gram-negative bacteria infection and reduce the levels of CRP, TNF-α and IL-6, but has no effect on the levels of ET and IL-10 as well as on 28-day mortality and ICU stay., 百拇医药(苏伟 杨智 许东琳 杨自力) 第 1 2 3 4 页 下一页
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