血浆置换联合连续性静-静脉血液滤过在严重脓毒症治疗中的应用

摘要

目的：确定血浆置换联合连续性静-静脉血液滤过治疗严重脓毒症的有效性。方法满足纳入标准的患者(n=118)随机分为三组， A组(n=53)、B组(n=49)及C组(n=16)；A组常规治疗， B组、C组在常规治疗基础上加用连续性静-静脉血液滤过治疗及血浆置换联合连续性静-静脉血液滤过治疗；比较三组间治疗3 d后APACHE II评分、SOFA评分及第28天死亡率。结果B组和C组治疗3 d后APACHE II评分、SOFA评分下降，第28天死亡率下降， C组均显著低于A组(P<0.05)。结论血浆置换联合连续性静-静脉血液滤过能够作为严重脓毒症的有效辅助手段，可降低死亡率。%Objective To determine the therapeutic efficacy of plasmapheresis combined with continuous venovenous hemofiltration in the treatment of severe sepsis.Methods Patients who meet the accepting criteria, 118 cases in total, were randomly divided into three groups-group A (n=53), group B (n=49) and group C (n=16). Group A was treated with standard therapy, and group B and group C received the add-on treatment with plasmapheresisor or the add-on treatment with plasmapheresis combined with continuous venovenous hemofiltration. The APACHE II score and SOFA score after 3 days and 28-day mortality rate were compared in three groups.Results The APACHE II score and SOFA score after 3 days was significantly lower in group B and group C. The 28-day mortality rate of group C was significantly lower than group A (P<0.05). Conclusion Plasmapheresis combined with continuous venovenous hemofiltration may be an important adjuvant for conventional treatment of patients with severe sepsis to reduce mortality rate.