Objective To investigate impact of continuous venovenous hemodiafiltration on pulmonary function of multiple trauma patients complicated with postoperative sepsis.Methods A total of 48 multiple trauma patients complicated with postoperative sepsis were selected in the First Hospital of Danjiangkou from February to December in 2016,and they were randomly divided into control group and observation group,each of 24 cases.Patients of control group received conventional treatment,while patients of observation group received continuous venovenous hemodiafiltration based on conventional treatment.Inflammatory mediators,index of oxygenation function,respiratory mechanical index and index of pulmonary capillary permeability before treatment,after 12 hours,24 hours,48 hours and 72 hours of treatment were compared between the two groups;patients of the two groups were followed up for 1 month,and incidence of death was recorded during the follow-up.Results There was interaction between time and method in serum levels of IL-6,IL-10 and TNF-α (P ＜ 0.05);main effects of time and method were significant in serum levels of IL-6,IL-10 and TNF-α (P ＜ 0.05);after 24 hours,48 hours and 72 hours of treatment,serum levels of IL-6,IL-10 and TNF-α of observation group were statistically significantly lower than those of control group (P ＜ 0.05).There was interaction between time and method in PA-aDO2 and oxygenation index (P ＜ 0.05);main effects of time and method were significant in PA-aDO2 and oxygenation index (P ＜0.05);after 12 hours,24 hours,48 hours and 72 hours of treatment,PA-aDO2 of observation group was statistically significantly lower than that of control group,respectively,while oxygenation index of observation group was statistically significantly higher than that of control group,respectively (P ＜ 0.05).There was interaction between time and method in PIP and Cdyn (P ＜ 0.05);main effects of time and method were significant in PIP and Cdyn (P ＜ 0.05);after 24 hours,48 hours and 72 hours of treatment,PIP of observation group was statistically significantly lower than that of control group,respectively,while Cdyn of observation group was statistically significantly higher than that of control group,respectively (P ＜ 0.05).There was no interaction between time and method in Raw (P ＞ 0.05);main effect of time or method was not statistically significant in Raw (P ＞ 0.05).There was interaction between time and method in EVLW and PVPI (P ＜ 0.05);main effects of time and method were significant in EVLW and PVPI (P ＜ 0.05);after 12 hours,24 hours,48 hours and 72 hours of treatment,EVLW of observation group was statistically significantly less than that of control group,respectively,meanwhile PVPI of observation group was statistically significantly lower than that of control group,respectively (P ＜ 0.05).Fatality rate of observation group was statistically significantly lower than that of control group during the follow-up (P ＜ 0.05).Conclusion Continuous venovenous hemodiafiltration has certain pulmonary function protective effect in multiple trauma patients complicated with postoperative sepsis,can effectively relive the inflammatory reaction,improve the oxygenation function,respiratory mechanical index and pulmonary capillary permeability.%目的 探讨连续性血液透析滤过对多发创伤术后并发脓毒症患者肺功能的影响.方法 选取2016年2-12月丹江口市第一医院收治的多发创伤术后并发脓毒症患者48例,随机分为对照组和观察组,每组24例.对照组患者给予常规治疗,观察组患者在常规治疗基础上给予连续性血液透析滤过治疗.比较两组患者治疗前及治疗后12 h、24h、48 h、72 h炎性递质、氧合功能指标、呼吸力学指标及肺毛细血管通透性指标;两组患者均随访1个月,记录随访期间死亡情况.结果 时间与方法在血清白介素6 (IL-6)、白介素10 (IL-10)、肿瘤坏死因子α(TNF-α)水平上存在交互作用(P＜0.05);时间和方法在血清IL-6、IL-10、TNF-α水平上主效应显著(P＜0.05);治疗后24h、48 h、72 h观察组患者血清IL-6、IL-10、TNF-α水平低于对照组(P＜0.05).时间和方法在肺泡-动脉血氧分压差(PA-aDO2)、氧合指数上存在交互作用(P＜0.05);时间和方法在PA-aDO2、氧合指数上主效应显著(P＜0.05);治疗后12 h、24h、48 h、72 h观察组患者PA-aDO2低于对照组,氧合指数高于对照组(P＜0.05).时间和方法在气道峰压(PIP)、肺动脉顺应性(Cdyn)上存在交互作用(P＜0.05);时间扣方法在PIP、Cdyn上主效应显著(P＜0.05);治疗后24 h、48 h、72 h观察组患者PIP低于对照组,Cdyn高于对照组(P＜0.05).时间和方法在气道阻力(Raw)上无交互作用(P＞0.05);时间和方法在Raw上主效应不显著(P＞0.05).时间和方法在血管外肺水(EVLW)和肺血管通透性指数(PVPI)上存在交互作用(P＜0.05);时间和方法在EVLW和PVPI上主效应显著(P＜0.05);治疗后12 h、24h、48 h、72 h观察组患者EVLW少于对照组,PVPI低于对照组(P＜0.05).观察组患者随访期间病死率低于对照组(P＜0.05).结论 连续性血液透析滤过可有效减轻多发创伤术后并发脓毒症患者炎性反应,改善患者氧合功能、呼吸力学指标及肺毛细血管通透性,具有一定的肺功能保护作用.
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