摘要目的 探讨脓毒性休克合并急性肾功能衰竭患者行不同剂量连续性静-静脉血液滤过对血管活性药物应用的影响.方法 20例脓毒性休克合并急性肾功能衰竭患者,按置换液剂量随机分为低剂量组(35 ml·kg-1 ·h-1)和高剂量组(55ml·kg-1·h-1)行连续性静-静脉血液滤过治疗,所有患者治疗前调整血管活性药物(去甲肾上腺素)剂量,使平均动脉压＞ 65 mm Hg(1 mmHg=0.133kPa).比较两组患者0、6、12、24h时去甲肾上腺素用量和平均动脉压水平；比较两组患者连续性静-静脉血液滤过前和治疗24h后氧合指数、乳酸、尿素氮、肌酐、超敏C反应蛋白、降钙素原、急性生理功能和慢性健康状况评分系统Ⅱ评分等指标；并比较两组患者72 h和24h尿量.结果 两组患者年龄、液体输入量、连续性静-静脉血液滤过平均治疗时间、治疗前平均动脉压、去甲肾上腺素用量、氧合指数、乳酸、尿素氮、肌酐、超敏C反应蛋白、降钙素原、急性生理功能和慢性健康状况评分系统Ⅱ评分、尿量比较差异无统计学意义(P＞0.05)；治疗开始后两组患者去甲肾上腺素用量均逐渐减少,但差异无统计学意义(P＞0.05).高剂量组患者去甲肾上腺素用量较低剂量组患者减少更迅速,连续性静-静脉血液滤过治疗24h时高剂量组患者去甲肾上腺素总量与低剂量组患者比较差异有统计学意义(P＜0.05).两组患者治疗24h后氧合指数、乳酸、尿素氮、肌酐、超敏C反应蛋白、降钙素原、急性生理功能和慢性健康状况评分系统Ⅱ评分等指标比较差异均有统计学意义(P＜0.05).高剂量组患者超敏C反应蛋白、降钙素原、急性生理功能和慢性健康状况评分系统Ⅱ评分等指标与低剂量组患者比较差异有统计学意义(P＜0.05).低剂量组患者72、24h尿量与高剂量组患者比较略多,但差异无统计学意义(P＞0.05).结论 高剂量组患者经连续性静-静脉血液滤过治疗后,脓毒性休克合并急性肾功能衰竭患者的血管活性药物用量减少,超敏C反应蛋白、降钙素原、急性生理功能和慢性健康状况评分系统Ⅱ评分等指标下降更明显,有助于此类患者早期病情的缓解.

abstractsObjective It's to evaluate the influence of different doses continuous venovenous hemofiltration(CVVH) on vasoactive drug use in septic shock(SS) with acute renal failure(ARF).Methods According to the volume of substitute fluid in CVVH,20 patients with SS and ARF were randomized to divide into two groups:low dosage group (35 ml· kg-1 ·h-1) or high dosage group (55 ml·kg-1 ·h-1).Vasoactive drug(norepinephrine,NE) was adjusted to reach a mean arterial pressure(MAP) ＞ 65 mm Hg (1 mm Hg=0.133 kPa).We compared NE dose and MAP at 0,6,12,24 h.And we compared oxygenation index,lactate,urea nitrogen(BUN),serum creatine(Cr),high-sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT),APACHE Ⅱ score and daily urine output after 72 hours after CVVH.Results There is no significances in age,input of the liquid,average CVVH treatment time,MAP,NE doses,oxygenation index,lactate,BUN,Cr,hs-CRP,PCT,APACHE Ⅱ score and daily urine output between two groups before CVVH (P ＞ 0.05).NE doses of two groups gradually reduced during CVVH,but the changes have no significance(P ＞ 0.05).NE doses decreased more rapidly of high dosage group compared to low dosage group.After 24-hour CVVH,NE quantity of high dosage group is lower than low dosage group(P ＜ 0.05).After 24-hour CVVH,oxygenation index,lactate,BUN,Cr,hs-CRP,PCT and APACHE Ⅱ score improved significantly in all the patients(P ＜ 0.05).PCT,hs-CRP,and APACHE Ⅱ score decreased significantly in high dosage group(P ＜ 0.05).After 72h CVVH,24h urine output was increased slightly in the high dosage group(P ＞ 0.05).Conclusion In high dosage group CVVH can decrease NE dose,and decrease hs-CRP,PCT,APACHE Ⅱ more quickly,release SS with ARF early.