目的：探讨高容量血液滤过(HVHF)改善脓毒症患者的肺和肾功能的效果。方法选取2013年1月~2014年10月新疆维吾尔自治区中医医院重症医学科收治的58例脓毒症伴急性肺肾损伤患者，按入院先后顺序随机分为对照组(35例)及HVHF组(23例)，对照组采用常规治疗，HVHF组在对照组基础上加用连续性HVHF治疗，观察对比两组患者72 h后的动脉血乳酸(Lac)、血清高敏C反应蛋白(hs-CRP)、肺泡氧分压与动脉氧分压的差值[P(A-a)DO2]、氧合指数(OI)、血清胱抑素(Cys C)、血清肌酐清除率(CCr)。结果经治疗72 h后，HVHF组较对照组血Lac、hs-CRP下降[Lac：(1.6±0.5)比(2.6±1.3)mmol/L、hs-CRP：(35.8±18.4)比(97.3±20.2)mg/L]，差异有统计学意义(P<0.05)；HVHF组的肺指标P(A-a)DO2、OI也较对照组有明显改善[P(A-a)DO2：(114±22)比(155±23)、OI：(295±38)比(139±32)]，差异有统计学意义(P<0.05)；HVHF组的肾功能指标Cys C、CCr较对照组明显好转[Cys C：(2.10±1.21)比(3.93±2.07)mg/L、CCr：(108.6±31.2)比(90.1±32.1)]，差异有统计学意义(P<0.05)；治疗7 d后，对照组患者的病死率为28.57%，HVHF组患者的病死率为17.39%，两组比较差异有统计学意义(P<0.05)。结论连续性高容量血液滤过能有效改善脓毒症急性肺肾损伤患者的肺肾功能，可防治多器官功能障碍综合征的发生，提高患者的生存率。%Objective To observe the effect of high volume hemofiltration on improving sepsis patients with acute lung and kidney damage. Methods From January 2013 to October 2014, in ICU, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, 58 septic patients with acute lung injurg (ALI) and acute kidney injury (AKI) were selected. All the patients were randomly divided into control group (35 cases) and HVHF group (23 cases) according to the order of admission. The patients in control group were given routine treatment, the patients in HVHF group were given HVHF treatment on the basis of routine treatment. The Lac, hs-CRP, P (A-a)DO2, OI, Cys C, CCr after 72 h in two groups were observed and compared. Results After treatmout 72 h, Lac, hs-CRP in HVHF group were lower than those in con-trol group [Lac:(1.6±0.5)vs (2.6±1.3) mmol/L, hs-CRP:(35.8±18.4)vs (97.3±20.2) mg/L], the differences were statistical-ly significant (P< 0.05). P(A-a)DO2, OI, Cys C, CCr in HVHF group were better than those in control group [P(A-a)DO2:(114±22) vs (155±23), OI: (295±38) vs (139±32), Cys C: (2.10±1.21) vs (3.93±2.07) mg/L, CCr: (108.6±31.2) vs (90.1±32.1)], the differences were statistically significant (P<0.05). After treatmout 7 d, the death rate of control group was 28.57%, the death rate of HVHF group was 17.39%, two groups was compared, the difference was statistically signifi-cant (P<0.05). Conclusion HVHF can improve the organ function in patients with ALI and AKI, at the same time, it can take precaution multiple organ dysfunction syndrome(MODS), and improve the survival rate of patients.
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