Effects of high—volume hemofiltration on alveolar—arterial oxygen exchange in patients with refractory septic shock.docVIP

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2017-09-19 发布于福建
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Effects of high—volume hemofiltration on alveolar—arterial oxygen exchange in patients with refractory septic shock.doc

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Effects of high—volume hemofiltration on alveolar—arterial oxygen exchange in patients with refractory septic shock

Effects of high—volume hemofiltration on alveolar—arterial oxygen exchange in patients with refractory septic shock BACKGROUND： High-volume hemofiltration （HVHF） is technically possible in severe acute pancreatitis （SAP） patients complicated with multiple organ dysfunction syndrome （MODS）. Continuous HVHF is expected to become a beneficial adjunct therapy for SAP complicated with MODS. In this study， we aimed to explore the effects of fluid resuscitation and HVHF on alveolar- arterial oxygen exchange， the Acute Physiology and Chronic Health Evaluation II （APACHE II） score in patients with refractory septic shock. METHODS： A total of 89 refractory septic shock patients， who were admitted to ICU， the Provincial Hospital affiliated to Shandong University from August 2006 to December 2009， were enrolled in this retrospective study. The patients were randomly divided into two groups： fluid resuscitation （group A， n=41）， and fluid resuscitation plus high-volume hemofiltration （group B， n=48）. The levels of O2 content of central venous blood （CcvO2）， arterial oxygen content （CaO2）， alveolar-arterial oxygen pressure difference P（A–a）DO2， ratio of arterial oxygen pressure/alveolar oxygen pressure （PaO2/PAO2）， respiratory index （RI） and oxygenation index （OI） were determined. The oxygen exchange levels of the two groups were examined based on the arterial blood gas analysis at different times （0， 24， 72 hours and 7 days of treatment） in the two groups. The APACHE II score was calculated before and after 7-day treatment in the two groups. RESULTS： The levels of CcvO2， CaO2 on day 7 in group A were significantly lower than those in group B （CcvO2： 0.60±0.24 vs. 0.72±0.28， P70%）， and urinary volume0.5 mL/kg per hour.[5] In group B， except for fluid resuscitation， the patients continued to receive high-volume hemofiltration （HV-CVVH） for at least 72 hours. Indwelling catheters （Prismaflex corporation， Switzerland） in the femoral vein were adopted for vascular access in