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目的观察不间断连续性血液净化(CBP)治疗严重脓毒症并毛细血管渗漏(CLS)的疗效。方法按随机原则将严重脓毒症并出现毛细血管渗漏患者分为常规对照组25例和治疗组25例,两组患者均按2012严重脓毒症和脓毒症休克治疗指南的早期集束化治疗方案进行治疗,常规对照组采用间断连续性静-静脉血液滤过(CVVH),每日治疗12小时;治疗组不间断连续性血液净化治疗,分别于治疗前及治疗24、48、72h后行动脉血气分析,观察患者ICU住院时间、机械通气时间及28d病死率。结果治疗组ICU住院时间及机械通气时间均显著低于常规对照组(P<0.05),28d病死率明显低于常规对照组(P<0.05),治疗72h后,治疗组APACHEII评分均明显下降,治疗组治疗后24、48、72h氧合指数均较治疗前明显增高(P<0.05),且较常规对照组(24、48、72h)同期明显增高(P<0.05)。结论不间断连续性血液净化治疗能明显减轻严重脓毒症患者毛细血管渗漏,改善预后。
Objective To observe the curative effect of continuous continuous blood purification (CBP) on severe sepsis and capillary leak (CLS). Methods According to the randomized principle, patients with severe sepsis and capillary leakage were divided into routine control group (n = 25) and treatment group (n = 25). Both groups were pre-clustered according to the 2012 guidelines for the treatment of severe sepsis and septic shock The patients in the control group were treated with intermittent continuous venovenous hemofiltration (CVVH) for 12 hours daily. The treatment group was treated with continuous blood purification for 24, 48 and 72 hours Arterial blood gas analysis, observation ICU hospitalization time, mechanical ventilation time and 28d mortality. Results The ICU hospitalization time and mechanical ventilation time in the treatment group were significantly lower than those in the control group (P <0.05), and the mortality at 28 days was significantly lower than that in the control group (P <0.05). After 72 hours of treatment, the APACHEII scores of the treatment group were significantly decreased The oxygenation index of the treatment group at 24, 48 and 72h after treatment was significantly higher than that before treatment (P <0.05), and significantly higher than that of the control group at 24, 48 and 72h (P <0.05). Conclusion Continuous, continuous blood purification can significantly reduce the capillary leakage in patients with severe sepsis and improve prognosis.