国际麻醉学与复苏杂志   2018, Issue (6): 8-8
    
连续血液净化应用于围手术期脓毒症性休克患者临床效果的研究
曹天彪, 宋文学1()
1.甘肃省瓜州县人民医院
The effects of continuous blood purification in patients with septic shock during perioperative period
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摘要：

目的　评价连续血液净化在围手术期脓毒症性休克患者中应用的临床效果。　方法　选择围手术期脓毒症性休克患者47例，按疾病种类采用随机数字表法分为试验组（D组，23例）和对照组（F组，24例）。D组于确定手术即刻起建立静脉?蛳静脉血管通路接血液净化机开始超滤，持续血液净化至术后72 h，F组仅于术后常规血液净化至72 h。观察记录两组患者术前（血液净化前，T0）、术毕（T1）、术后24 h（T2）、术后48 h（T3）、术后72 h（T4）的血pH、氧合指数、HCO3-、碱剩余（base excess, BE）、BUN、血清肌酐（serum creatinine, SCr）及SBP、DBP和HR，同时记录手术时间及围手术期多巴胺、阿拉明用量以及术后治愈患者例数。　结果　F组多巴胺、阿拉明用量明显多于D组，差异有统计学意义（P<0.05）。D组治愈率91.3%；F组治愈率70.8%，两组比较差异有统计学意义（P<0.05）。与T0比较，D组T1~T4时SBP、DBP明显增高，HR明显降低（P<0.05）；F组T3、T4时SBP、DBP明显增高，HR明显降低（P<0.05）。F组T2、T3时SBP、DBP明显低于D组（P<0.05），HR明显高于D组（P<0.05）。D组T1~T4时血pH、HCO3-较T0时均升高，但差异无统计学意义（P>0.05）；T2~T4时氧合指数、BE 较T0时明显升高（P<0.05）；T2~T4时BUN、SCr较T0时明显下降，差异有统计学意义（P<0.05）。F组T2~T4时血pH、HCO3-较T0时均升高，但差异无统计学意义（P>0.05）；T4时氧合指数、BE较T0明显升高（P<0.05），BUN、SCr较T0明显下降（P<0.05）。F组T1~T4时血pH、HCO3-较 D组下降，但差异无统计学意义（P>0.05）；T2~T4时氧合指数较 D组明显下降（P<0.05）；T1~T4时BE较 D组下降，但差异无统计学意义（P>0.05）；T1~T4时BUN、SCr较D组均升高，但差异无统计学意义（P>0.05）；F组T0 时各项生化指标与D组比较，差异无统计学意义（P>0.05）。　结论　连续血液净化用于围手术期脓毒症性休克患者取得了满意的临床效果，可维持内环境及血流动力学稳定，减少血管活性药物的用量，提高患者耐受力，增加机体应激反应性，改善麻醉和手术条件，降低麻醉和手术风险，进而增加患者治愈率、提高患者康复率。
关键词： 围手术期；　脓毒性休克；　连续血液净化
Abstract:

Ｏｂｊｅｃｔｉｖｅ　To evaluate the effects of continuous blood purification in patients with septic shock during perioperative period.　Methods　Forty-seven patients with infectious shock during perioperative period were enrolled and randomly divided into experimental group(group D, n=23) and control group(group F, n=24). Patients in group D received continuous venous hemofiltration starting before surgery till 72 hours after surgery. Patients in group F were treated with blood purification for 72 hours postoperatively. The blood oxygenation index, pH, HCO3-, base excess(BE)，BUN, serum creatinine(SCr), SBP, DBP and HR were recorded in the two groups before surgery (T0), by the end of operation (T1), and 24 h (T2), and 48 h (T3), and 72 h (T4) after operation. The duration of operation, the perioperative doses of dopamine and metaraminol, and the recovery rate of patients were recorded, as well.　Results　Doses of dopamine and alamin in group D were significantly lower than those in group F (P<0.05). The recovery rate in group D (91.3%) was significantly higher than that in group F (70.8%) (P<0.05). In group D, compared to those at T0, SBP and DBP at T1-T4 were significantly increased, but HR was reduced(P<0.05). In group F, compared to those at T0, SBP and DBP at T3, T4 were significantly increased, but HR was reduced(P<0.05). Compared to group D, SBP and DBP at T2, T3 were significantly reduced, but HR was increased in group F(P<0.05). In group D, blood pH and HCO3- at T1-T4 did not differ from those at T0, however, the oxygenation index, BE, BUN and SCr at T2-T4 were significantly different from those at T0(P<0.05). In group F, compared to T0, blood pH and HCO3- at T2-T4 did not change, oxygenation index and BE at T4 were significant increased(P<0.05). BUN and SCr at T4 were significantly decreased(P<0.05). Compared to group D, there were no difference in blood pH and HCO3- at T1-T4(P>0.05), there was significant difference in oxygenation index at T2-T4 (P<0.05) and there was no difference in BE at T1-T4 in group F(P>0.05). There were no significant difference in biochemical indexes between group F and group D at T0 (P>0.05).　Conclusions　Continuous blood purification for perioperative patients with septic shock improved patients′ outcome: stabilizing homeostasis, maintaining the hemodynamics, reducing the doses of vasoactive drugs, improving patients′ tolerance and recovery rate.
Key words: Perioperative period;　Septic shock;　Continuous blood purification