连续血液净化串联血液灌流治疗尿源性脓毒血症的效果分析

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摘要目的探讨连续血液净化串联血液灌流治疗尿源性脓毒血症患者的临床疗效。方法回顾分析2010年1月～2015年6月我院收治患者中出现尿源性脓毒血症的23例患者的临床资料，采用常规液体复苏治疗基础上结合连续血液净化串联血液灌流治疗，比较其治疗前、后生命体征，肾功能及炎症指标水平的变化。　结果除1例患者死亡外，其余经治疗患者生命体征在48 h后基本趋于稳定，感染检测指标与SCr均有下降，治疗72 h后，降钙素原、C-反应蛋白及细胞因子TNF-α、IL-6的水平与治疗前比较明显降低，差异有统计学意义（P＜0.05）。平均住院天数为11 d，无明显后遗症。　结论尿源性脓毒血症重在预防，泌尿系感染患者术前应规范抗感染治疗，术中密切观察，出现血压下降、寒战或创面异常出血等应立即终止手术，及时采取液体复苏并应用连续血液净化串联血液灌流，可降低尿源性脓毒血症患者的炎性介质水平，有效控制病情发展。

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	陈深泉
	黎鉴飞
	陈以明
	吴保忠

关键词 ：尿源性脓毒血症, 连续血液净化, 液体复苏, 血液灌流

Abstract：Objective To investigate the c1inica1 effects of continuous b1ood purification in tandem with hemoperfusion in the treatment of patients with urogenous sepsis.Methods 23 patients with urogenous sepsis who were admitted in our hospita1 from January 2010 to June 2015 were retrospective1y ana1yzed.Continuous b1ood purification in tandem with hemoperfusion on the basis of conventiona1 f1uid resuscitation was performed on the patients.The changes of vita1 signs，kidney functions and inf1ammation indexes 1eve1 before and after the treatment were compared.Results Besides 1 case of death，the vita1 signs of a11 the other patients tended to be stab1e 48 hours after the treatment and the infectiondetective indexes as we11 as the SCr was decreased respective1y.Among them，the 1eve1 of proca1citonin，C-reactive protein，cytokines TNF-αand IL-6 72 hours after the treatment was a11 significant1y 1ower than that before the treatment respective1y and the differences had statistica1 significance（P＜0.05）.The average discharge date was 11 days without obvious seque1.Conclusion Prevention is important in urogenous sepsis.Regu1ar anti-infectious treatment shou1d be given to the patients with uro1ogica1 infections before the operations.During the operation，the patients shou1d be carefu11y observed and once fa11 of b1ood pressure，shiver and abnorma1 b1eeding at the wound occurs，the operation shou1d be terminated at once.Time1y 1iquid resuscitation and the app1ication of continuous b1ood purification in tandem with hemoperfusion can decrease the 1eve1 of inf1ammatory mediators and effective1y contro1 the deve1opment of the disease.

Key words： Urogenous sepsis Continuous b1ood purification Liquid resuscitation Hemoperfusion

作者简介: 陈深泉（1982-），男，硕士，主治医师

引用本文:

陈深泉；　黎鉴飞；　陈以明；　吴保忠. 连续血液净化串联血液灌流治疗尿源性脓毒血症的效果分析[J]. 中国当代医药, 2016, 23(13): 60-63.
CHEN Shen-quan； LI Jian-fei； CHEN Yi-ming； WU Bao-zhong. Clinical effects of continuous blood Purification in tandem with hemoPerfusion in the treatment of urogenous sePsis. 中国当代医药, 2016, 23(13): 60-63.

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