连续性肾脏替代治疗联合高容量血液灌流对多重耐药菌感染性休克患者短期预后的影响OA
The Influence of CRRT Combined With High-Volume Hemoperfusion on the Short-Term Prognosis of Patients With Multi-Drug Resistant Bacterial Septic Shock
目的 分析连续性肾脏替代治疗(CRRT)联合高容量血液灌流对多重耐药菌感染性休克患者短期预后的影响.方法 选择110例于2021年1月至2024年1月在本院就诊的多重耐药菌感染性休克患者,采用随机数字表法将其分为对照组(CRRT治疗,n=55)、观察组(CRRT联合高容量血液灌流,n=55).比较两组治疗前后血流动力学指标[心率、中心静脉压(CVP)及血清乳酸]、炎症因子水平[白介素-6、降钙素原、C反应蛋白]、血气指标[二氧化碳分压(PaCO2)、血氧饱和度(SaO2)、酸碱度(pH)及呼吸频率]、预后相关指标[ICU住院时间、机械通气时间以及合并多器官功能障碍综合征(MODS)、28 d死亡、90 d死亡发生率].结果 治疗后两组心率、血清乳酸、CVP水平均低于治疗前,观察组心率、血清乳酸、CVP水平低于对照组(P<0.05);治疗后两组炎症因子水平均呈下降趋势,观察组炎症因子下降幅度优于对照组(P<0.05);治疗后两组PaCO2、SaO2及pH值呈升高趋势,呼吸频率呈下降趋势,组间比较血气指标有明显差异(P<0.05);观察组ICU住院时间、机械通气时间短于对照组,合并MODS、28 d死亡、90 d死亡发生率低于对照组(P<0.05).结论 CRRT联合高容量血液灌流治疗多重耐药菌感染性休克可有效稳定患者生命体征,改善其炎症反应、血流动力学及血气指标,降低MODS发生风险及病死率,改善预后.
Objective To analyze the effect of continuous renal replacement therapy(CRRT)combined with high-vol-ume hemoperfusion on the short-term prognosis of patients with multi-drug resistant bacterial septic shock.Methods A total of 110 patients with multi-drug resistant bacterial septic shock admitted to our hospital from January 2021 to January 2024 were enrolled.According to the random number table method,they were divided into the control group(treated with CRRT alone,n=55)and the observation group(treated with CRRT combined with high-volume hemoperfusion,n=55).Hemodynamic indica-tors[heart rate,central venous pressure(CVP)serum lactic acid]inflammatory factors levels[interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP)]before and after treatment were compared between the two groups.Blood gas indicators[partial pressure of carbon dioxide(PaCO2),blood oxygen saturation(SaO2),pH value,respiratory rate]and prognostic related indica-tors[length of ICU stay,duration of mechanical ventilation,incidence of combined multiple organ dysfunction(MODS),28-day mortality rate,and 90-day mortality rate]were also compared.Results After treatment,the heart rate,serum lactic acid level and CVP of both groups were lower than those before treatment,and the above indexes in the observation group were lower than those in the control group(P<0.05).The levels of inflammatory factors in both groups showed a downward trend after treatment,and the reduction amplitude in the observation group was more significant than that in the control group(P<0.05).After treat-ment,PaCO2,SaO2 and pH values were increased,while the respiratory rate was decreased.There were significant differences in blood gas indexes between the two groups(P<0.05).The length of stay in the ICU and the duration of mechanical ventilation in the observation group were shorter than those in the control group,and the incidences of combined MODS,28-day mortality rate,and 90-day mortality rate were lower than those in the control group(P<0.05).Conclusion CRRT combined with high-volume hemoperfusion in the treatment of mortality rate multi-drug resistant bacterial septic shock can effectively stabilize the vital signs of patients,alleviate their inflammatory responses,improve hemodynamics and blood gas indicators,reduce the risk of MODS and mortality,and further improve the short-term prognosis of patients.
赵帆;何剑成;邢朝阳;郑涛
广元市第一人民医院重症医学科,四川 广元 628017广元市第一人民医院重症医学科,四川 广元 628017广元市第一人民医院重症医学科,四川 广元 628017广元市第一人民医院重症医学科,四川 广元 628017
连续性肾脏替代治疗高容量血液灌流多重耐药菌感染性休克多器官功能衰竭预后
continuous renal replacement therapyhigh-volume hemoperfusionmulti-drug resistant bacteriainfectious shockmultiple organ failureprognosis
《中国体外生命支持》 2026 (2)
127-131,5
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