DIEN DAN Y HOC
Nghien CLPU khoa hoc
DANH GIA HIEU QUA HUYET DONG CUA LOC MAU LIEN TUC 6 BENH NHAN SOC N H I I M KHUAN
Bui Van Tam*, Dang Quoc Tuan*
TOMTAT
Dat van de: trong thdi gian gdn day LMLTdd duac nhieu tdc gid chi dinh trong dieu tri sdc nhiem khudn (SNK) vd da cho thdy tdc dung tdt trong cdi thiin tinh trgng huyit dpng. Muc tieu nghien ciiu: ddnh gid hiiu qud huyit dpng cita Ipc mdu liin tuc a binh nhdn SNK. Phuong phap nghien ciiu: chdn dodn vd xir tri ca bdn SNK theo huang ddn cita chuang trinh Surviving Sepsis Campaign 2008. LMLT vdi mdng he AN 69 (dien tich 0,9 m-). Dich thay thi Hemosol hoac citrate, tdc dp dich thay thi 45 ml/kg/gia. Ket qua.- 48 BN, trong dd 16 BN duac dgt catheter Swan-Ganz, tudi 60,0 ± 16,0 (24-90), 38nam, lOnie. Thay ddi cdc thdng sd huyet ddng: mgch gidm cdy nghTa (p<0,001) tie gid thir 6 a nhdm sdng. HA trung binh tdng (p<0,001) tir gia thu 6dcd hai nhom.
Tir gid thu 12 HA trung binh a nhdm sdng cao han cd y nghTa so vdi nhdm tir vong. CO, CI tdng a tdt cd cdc BN trong ngcty ddu, sau 3d gidm cdy nghTa thdng kii (p<0,05) tie gid thie 24 vd vdn trong giai hgn cao. SRVtdngcd y nghTa thdng ke tie gia thie 6&cd nhdm sdng vd tie vong. Tie gid thie 6 SVdnhdm sdng cao han cd y nghTa thdng ki so vai nhdm tie vong. CVP vd PCWP khdng thay ddi cd y nghTa. Ket luan.' tinh trgng huyet dpng ciia BNSNK duac cdi thiin khi LMLT (tdn so tim gidm, HA trung binh vd siec cdn mgch hi thdng tdng, cung luprng tim vd chi sd tim gidm ddn vi tri sd binh thiedng). Tiin luprng nang khi cdc chi sd huyit dpng kim cdi thiin.
I. DAT VAN DE
Sdc nhiem khuan (SNK) la mdt benh ly nang, thudng gap va ty le tu' vong cao hang dau trong cac khoa Hdi sue cap cuu. Trong sinh benh hgc ciia SNK, ngudi ta thay rang su xuat hien cua cac cytokine gay viem la yeu td chu yeu dan den sdc va suy da tang.
Dieu trj SNK ddi hdi cac bien phap tdng hgp bao gdm dieu trj nguyen nhan, bdi phu the tich tuan hoan va diing cac thudc van mach, dieu trj hd trg cac ca quan va dieu trj ca che benh sinh ciia SNK.
Lgc mau tTnh mach - tTnh mach lien tuc (LMLT), da dugc nghien ciiu va ap dung tii- nhieu nam nay vdi muc dich loai bd cytokine va cac chat hda tan, can bang nudc dien giai, kiem toan. Tuy nhien, hieu qua cua phuong phap nay d BN SNK cho den nay vin chua
* Khoa Hdi siec tich cue, Binh vien Bgch Mai
dat dugc su ddng thuan cao. Theo phan ldn cac tac gia, LMLT la bien phap dilu trj phdi hgp cd tac dung cai thien huyet ap (HA) frung binh va giam ty le tiir vong cd y nghTa, nhung cd tac gia lai cho rang hieu qua cua LMLT khdng thuc su tdt hon Igc mau ngat quang.
Muc tieu nghien cu'u: ddnh gid hiiu qud huyit dpng cita he mdu lien tuc a binh nhdn SNK.
n. DOI TU'ONG VA PITLTONG PHAP NGHIEN ClTU 1. Ddi tuung nghien ciru
48 benh nhan SNK dilu trj tai khoa Hdi sire tich cue, Benh vien Bach Mai, trong thdi gian 1/8/2008 din 31/8/2009.
Tieu chuin chin doan SNK: theo hudng dan hudng din qudc tl ciia chuong trinh SURVIVING SEPSIS CAMPAIGN [6].
- Cd hdi chung dap ung viem he thdng.
18 I Y H O C L A M S A N G ss 55 (Thang 08/2010)
- Cd d nhiem khuan hoac ciy mau duang tinh.
- HA tam thu < 90 mmHg hoac giam > 40 mmHg so vdi HA tam thu ca ban ciia benh nhan, khdng dap iing vdi bdi phu thi ti'ch, phai dimg thudc van mach de duy tri HA.
- Cd bieu hien giam tudi mau td chiic hoac rdi loan chirc nang ft nhit 1 ca quan.
Tieu chuan loai trii-: benh nhan vao vien qua mudn khdng kjp thuc hien diy du phac dd dieu trj;
SNK tren benh nhan cd benh giai doan cudi; benh nhan hoac gia dinh khdng ddng y thuc hien LMLT.
2. Phuong phap nghien cuu 2.1. Dieu tri kinh dien
Benh nhan ngay khi dugc chan doan xac djnh la SNK dugc dieu trj thdng nhat theo hudng dan qudc te cua chuong trinh Surviving Sepsis Campaign 2008.
- Phac do diiu tri:
+ Truyen djch (djch tinh the va hydroxyetyl starch) de cd CVP theo muc tieu dieu trj.
+Diingthudc van mach (dobutamin,noradrenalin) de duy fri HA trung binh (MAP) 65 mmHg.
+ Dieu trj tich cue d nhiem khuan bang khang sinh theo phac dd xudng thang, ket hgp dan luu hoac phau thuat neu cd chi djnh.
+ Dieu trj cac tang suy neu cd.
2.2. LMLThang may Prismaflex, mang lgc AN
Nghien CLPU khoa hoc
69 (dien tich 0,9 m2). Djch thay the Hemosol (chdng ddng theo phac do dimg heparin) hoac djch citrate.
Tdc do bom mau 180 - 200 ml/phut, tdc do djch thay the 45 ml/kg/gid. Hda loang trudc mang 50% (nlu chdng ddng bing heparin), hoac 100%o (nlu khdng diing heparin hoac khi diing djch citrate).
2.3. Cdc sd lieu cdn thu thdp
- Tudi, gidi, thdi gian nam vien, diem APACHE II, diem SOFA.
- Mach, HA trung binh.
- 16 benh nhan dugc dat catheter Swan Ganz do ap luc tTnh mach trung tam (CVP), ap lire mao mach phdi bit (PCWC), cung lugng tim (CO), tir do tinh ra chi sd tim (CI), sire can mach he thong (SRV), thi tich nhat bdp (SV).
- Cac thdi diem lay sd lieu: TO (vao vien hoac khi dugc xac dinh la SNK), Tl (gidtbii 6), T2 (gidthii 12), T3 (gid thir 24), T4 (gid thu' 48), T5 (gid thii 72).
III. KET QUA 1. Dac diem chung
Tir ngay 01/8/2008 din 31/8/2009, cd 48 BN SNK dugc LMLT trong dd, cd 16 BN dugc dat catheter Swan-Ganz.
Tudi trung binh 60,0 ± 16,0 (24-90) tudi. 38 BN nam (79,2%), 10 BN nii (20,8%).
So tang suy: 3,2± 1,0 (1-5), dilm APACHE II:
24,9 ± 5,6 (12-34), dilm SOFA: 13,5 ± 3,0 (7-20).
2. Su thay doi cac thdng so huyet ddng trong qua trinh LMLT
Bang 1. Su thay doi mgch trong qud trinh LMLT
Thdi diem TO Tl T2 T3 T4 T5
Mach (lan/phiit) Chung (n=48)
133,5 ±19,0 124,4 ±18,5***
122,2 ±20,8***
116,5 ±21,0***
111,5 ±24,7***
103,1 ±22,1***
Sdng (n=23) 132,9 ±19,9 119,2 ±20,2***
115,9 ±16,9***
109,7 ±19,4***
105,0±18,1***
99,2 ± 17,3***
Tir vong (n=25) 134,0 ±18,6 129,1 ±15,6 128,0 ±22,7 123,3 ±20,7*
123,8±31,3*
112,9 ±30,2*
P
>0,05
>0,05
>0,05
<0,05
<0,05
<0,05 'p<0,05; **p<0,01; ***p< 0,001 (so vdi TO).
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DIEN DAN Y HOC
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Mach giam cd y ngliTa vdi p < 0,001 tu gid thir 6 d nhdm song, trong khi nhdm tir vong mach chi giam cd y nghTa tir gid thii' 24.
Bdng 2. Su thay doi HA trung binh trong qud trinh LMLT
Thdi diem TO TI T2 T3 T4 T5
HA trung binh (mmHg) Chung (n=48)
69,0 ± 6,9 82,1 ± 9 , 3 * * * 81,8 ± 12,7***
83,5 ± 12,8***
85,7 ±12,0***
91,3 ±8,2***
Sdng (n=23)
69,7 ± 7,3 84,9 ± 10,2***
88,4 ±8,6***
89,2 ± 8,9***
90,3 ± 7,6***
93,3 ±7,7***
Tu vong (n=25) 68,3 ± 6,6 79,6 ±7,9***
75,7 ± 13,0**
77,9 ± 13,7***
76,8 ± 14,1**
86,1 ±7,4***
P
>0,05
>0,05
<0,05
<0,05
<0,05
<0,05 HA trung binh tang (p<0,001) tir gid thii 6 d ca hai nhdm. Tir gid thir 12 HA trung binh d nhdm sdng cao hon cd y nghTa so vdi nhdm tir vong.
Bdng 3. Su thay doi CVP trong qud trinh LMLT
Thoi diem TO Tl T2 T3 T4 T5
CVP thay ddi V
Thdi diem TO Tl T2 T3 T4 T5
CVP (mmHg) Chung (n=48)
9,9 ± 4,0 10,2 ± 3 , 3 10,3 ± 3 , 3 10,0 ± 3 , 4 9,3 ± 3,5 8,8 ± 2,9
Sdng (n=23) 9,0 ± 4,3 10,3 ± 3 , 7 10,2 ±3,1 9,4 ± 3,8 9,2 ± 3,5 8,4 ± 3 , 1 :hdng cd y nghia thdng ke.
Bang 4. Sutltaydoi PAWP trong qua
Tu vong (n=25) 10,7 ± 3 , 5 10,1 ± 3 , 1 10,5 ± 3 , 5 10,7 ± 2 , 9 9,7 ± 3 , 8 9,6 ± 2,5
truth LMLT
PAWP(mmHg) Chung (n=16)
13,6 ± 5 , 3 13,9 ± 4 , 4 14,2 ± 4 , 8 13,8 ± 4 , 9 12,7 ± 4 , 6 11,6±3,8
Sdng (n=8) 12,5 ± 5 , 1 13,3 ± 4 , 0 12,6 ±4,1 12,8 ± 5 , 3 11,4 ± 4 , 8 10,5 ± 3 , 0
Tu vong (n=8) 14,8 ± 5 , 5 14,6 ± 4 , 9 15,8 ± 5 , 2 14,8 ± 4 , 7 15,3 ± 3 , 2 14,3 ± 4 , 9
P
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
P
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05 Khac biet PAWP d nhdm tii vong cao hon nhdm sdng khdng cd y nghTa thdng ke.
20 I Y HOC L A M S A N G S6 55 (Thang 08/2010)
Nghien CCPU khoa hoc
: - ; J ^ . ; ' . ^ : :
Thdi diem TO Tl T2 T3 T4 T5
>' <^ , 1 Bdng 5. Su tliay ddi CI trong qud trinh LMLT CI (1/ph/m^)
Chung (n=16) 4,73 ± 1,18 4,60 ± 1,04 4,41 ± 1 , 0 1 * 4,05 ± 0,99**
3,91 ± 1,08**
3,65 ± 0,97***
Sdng (n=8) 4,95 ± 0,95 4,94 ± 0,94 4,81 ±0,96 4,39 ± 0,92*
4,15 ± 1,02*
3,75 ±0,83**
Tu vong (n=8)
4,51 ±1,40 4,25 ± 1,07 4,00 ± 0,93 3,70 ±0,98*
3,43 ±1,17*
3,38 ±1,48*
P
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05 CI tang d tat ca cac nhdm BN trong ngay dau, sau dd giam cd y nghTa thdng ke (p<0,05) tir gid thir 24 va van frong gidi ban cao.
Bdng 6. Su titay ddi SRV trong qud trinh LMLT
Thdi diem TO Tl T2 T3 T4 T5
SRV (dynes/giay/cm5) Chung (n=16)
714,3 ±243,4 872,5 ±262,7***
905,0 ±297,8***
1018,8 ±293,8***
1100,5 ±453,2***
1281,7 ±546,0***
Sdng (n=8)
674,6 ±235,1 845,9 ±229,5***
826,2 ±261,8**
926,4 ±186,7***
1066,6 ±281,3***
1218,8 ±367,6***
Tu vong (n=8)
754,0 ± 260,9 899,1±306,0**
983,8 ±327,5***
11I1,3±361,4***
1168,2 ±749,9***
.1449,6 ±979,6***
P
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05 SRV tang cd y nghTa thdng ke tir gid thir 6 d ca nhdm sdng va nhdm tii vong.
SV thay ddi khdng cd y nghTa trong qua trinh LMLT d nhdm sdng va nhdm tur vong khdng cd y LMLT. Tuy nhien, tir gid thir 6 SV d nhdm sdng cao nghTa thdng ke vdi p > 0,05. 0 nhdm sdng tir gid hon cd y nghTa thdng ke so vdi nhdm tii vong. thii 6 mach giam cd y nghTa thdng ke vdi p < 0,001,
:• •• .',;::;, . ' . den gid thii 72 mach chi cdn 99,2 ± 17,3. 6 nhdm TV. BAN LUAN tir vong mach ciing giam dan trong qua trinh LMLT.
1. Thay doi mach va HA trung binh Tuy nhien, phai din gid thii 24 mdi cd y nghTa thdng Mach trung binh frudc LMLT nhanh 133,5 ± ke (p < 0,05). Tir gid thir 24 mach d nhdm sdng giam 19,0, cd 47/48 BN SNK mach > 100 lin/phiit, cd hon cd y nghTa thdng ke so vdi nhdm tir vong.
tru'dng hgp len tdi 175 lin/phiit. Nghien ciiu cua Nhu vay, sau mdt thai gian dieu trj thi mach d Biii Thj Huong Giang thay, mach d thdi diem vao nhdm sdng thap ban nhdm tir vong va day chinh la khoa HSTC cua cac BN SNK la 126,3 ± 23,1 [2], diu hieu cho bilt BN cd dap irng vdi dilu trj. Tinh Trin Thanh Gang la 128 ± 7 [1], Payen la 112 ± 29 chung ca 2 nhdm mach giam cd y nghTa thdng ke [13], John la 114 ± 17 [7]. Khac biet vl mach trudc trong qua trinh LMLT, dilu nay cd the do LMLT
86 55 (Thang 08/2010) Y HOC L A M S A N G | 21
>
DIEN DAN Y HOC
Nghien cu-u khoa hoc
giup ha nhiet do d cac BN sdt, thanh thai cac cytokine gay viem dac biet la TNF - tac nhan gay mach nhanh trong sdc.
Theo nghien ciiu cua De Vriese, LMLT vdi tdc do mau 200 ml/phut se loai bd TNF - qua sieu Igc trung binh la 221,9 ± 44,6 pg/phut va qua hip phu la 2076,5 ± 497,0 pg/phiit [5]. Nghien ciru cua Tran Nggc Tuan tren 31 BN bdng nhiem khuan nang va SNK, thay rang cac cytokine gay viem nhu IL-2, IL-6, IL- 8, TNF - giam cd y nghTa thdng ke sau LMLT [4]. Mat khac, giam lieu thudc van mach va thudc trg tim ciing gdp phan lam cho mach giam.
HA trung binh trudc LMLT 69,0 6,9 mmHg.
35/48 BN (72,9%) cd HA trung binh trudc LMLT
>65 mmHg. Theo hudng dan ciia Surviving Sepsis Campaign, muc tieu can dat trong 6 gid dau la HA trung binh > 65 mmHg [6], bdi vi HA trung binh la bieu hien cua ap luc tudi mau, gia trj tdt nhat la tir 60-70 mmHg. Khi HA trung binh giam < 60 mmHg thi ddng mau den cac ca quan sdng bi giam xudng. HA trung binh tang cd y nghTa thdng ke vdi p < 0,001 trong qua trinh LMLT va bat dau tir gid thu 6. Cd nhieu nghien ciru cung cho rang LMLT cd tac dung cai thien HA trung binh d BN SNK [1], [3], [4], [7], [11].
Chung tdi nhan thay HA trung binh tang cd y nghTa thdng ke trong qua trinh LMLT d ca nhdm sdng va nhdm tii vong. Tuy nhien, tir gid thir 12 HA trung binh d nhdm sdng cao ban cd y nghTa thdng ke so vdi HA trung binh d nhdm tir vong (88,4 ± 8,6 so vdi 75,7 ± 13,0).
2. CVP va PAWP
Viec bdi phu the tich tuan hoan chua hoan toan dap iing dugc muc tieu de ra trong hudng dan xir fri SNK. CVP trung binh trudc LMLT la 9,9 ± 4,0 mmHg, cd 13 BN SNK chilm 27,1% trudc LMLT cd CVP dudi 8 mmHg. CVP thay ddi khdng cd y nghTa thdng ke trong va sau qua trinh LMLT va
duy tri xung quanh 9 mmHg. Theo hudng din cua Surviving Sepsis Campaign nam 2008, muc tieu trong 6 gid diu ein nang CVP len 8-12mmHg va duy tri d miic dd trong qua trinh dilu trj [6].
PAWP trung binh trudc LMLT la 13,6 ± 5,6 mmHg va duy tri xung quanh 13 mmHg trong qua trinh LMLT. PAWP trudc LMLT trong nghien ciiu cua chiing tdi thap hon nghien ciiu cua Jonh (16,7
± 4,4 mmHg) [7] va tuong tu nhu nghien cu'u ciia Payen la 14,7 ± 6,9 mmHg [13]. Theo nghien ciiu ciia Bill Thj Huong Giang, cac BN SNK thdi dilm nhap vien da cd tinh trang suy chu:c nang tam thu that trai [2]. PAWP trudc LMLT trong nghien ciiu ciia chiing tdi khdng tang cd the do cac BN nay da dugc diing thudc lam tang co bdp ca tim. PAWP thay ddi khdng cd y nghTa thdng ke trong qua trinh LMLT. So sanh PAWP d nhdm sdng va nhdm tir vong khac biet khdng cd y nghTa thdng ke d tat ca cac thdi diem. ^_^__
• 'I
3. Cung luung tim va chi sd tim
Tru'dc LMLT, CO frung binh la 7,48 ± 2,20 lit/
phut, CI trung binh la 4,73 ±1,18 lit/phut/ml Kit qua nay phii hgp vdi nghien ciru ciia Payen - CO frung binh la: 6,6 ± 1,9 [13], John - CO trung binh la 8,2 ± 2,0 [7]. CI trung binh trong nghien ciiru cua chiing tdi cao ban nghien ciru cua Page (3,2 ± 1,2) [12]. Mac dii, cac BN SNK trong nghien ciru ciia chiing tdi den vien mudn khi cd suy da tang nhung CO va CI vin tang. Cd the do cac BN nay deu da dugc chi djnh dimg dobutamin vdi lieu cao, trung binh la 17,0 ± 5,0 |ig/kg/ph. Trong qua frinh LMLT, CO va CI bit diu giam cd y nghTa tir gid thir 12 ve gia trj binh thudng. Cac nghien ciru nudc ngoai ve hieu qua cua LMLT tren huyet ddng d BN SNK deu thiy ring LMLT cd tac dung lam giam CO va CI cd ynghTatlidngke[5], [7], [10].
Khi so sanh giiia nhdm sdng va nhdm tir vong, CO va CI trong qua trinh LMLT khac biet khdng cd y nghTa thong ke. Metrangolo nghien cii'u fren 67
22 j Y HOC LAM SANG So 55 (Thang 08/2010)
Nghien cuu khoa hoc
BN SNK da thay rang khdng cd su khac biet ve cac thdng sd huyet ddng d nhdm sdng va tir vong d thdi diem nhap vien [9].
4. S R V v a S V
SRV trudc LMLT giam, trung binh la 714,3
± 243,4 (mac dii cac BN nay da dugc diing noradrenalin vdi lilu 0,91 ± 0,69 pg/kg/ph). SRV tang dan trong qua trinh LMLT va bit diu tang cd y nghTa thdng ke vdi p < 0,001 tii' gid thir 6 d ca nhdm BN sdng va tii' vong. Nhieu nghien ciru ve hieu qua ciia LMLT ciing cho ket qua tuang tu nhu nghien ciru ciia chiing tdi [5], [7], [8], [11].
So sanh SRV d nhdm sdng va nhdm tii vong khdng thay cd su khac biet cd y ngliTa thdng ke d tat ca cac thai diem.
SV trung binh trudc LMLT la 54,2 ± 13,9 ml/
nhjp, SV thay ddi khdng cd y nghTa thdng ke trong va sau qua trinh LMLT. Tuy nhien, khi so sanh hai nhdm sdng va tii vong thay rang: trudc LMLT SV khac biet khdng cd y nghTa thdng ke (59,7 ± 10,9 ml/nhjp so vdi 48,7 ± 15,1 ml/nhjp). Trong qua trinh LMLT, tir gid thii' 6 SV cua nhdm tu vong
thip hon cd y ngliTa thdng ke so vdi SV ciia nhdm sdng (p < 0,05). Trudc va trong qua trinh LMLT, SV d nhdm tir vong khdng tang tham chi cd trudng hgp giam thip (32,4 ml/nhjp), mac dii cung lugng tim va chi sd tim khdng giam. Nhu vay, cac BN d nhdm tii' vong deu da cd tinh trang suy'chiic ning that trai. Tuy nhien, chi sd tim khdng giam do da dugc diing dobutamin va cd tinh trang tang tan sd tim bii trir. Viec SV giam thip chinh la ylu to tien lugng xau.
V. KET LUAN
1. Khi LMLT vdi toe do djch thay thi cao 45 ml/kg/gid trong dieu trj SNK, chiing tdi thiy tinh trang huyet ddng duuc cai thien, chu ylu ff nhom song
- Tan sd tim giam.
- HA frung binh va siic can mach he thdng tang.
- Cung lugng tim va chi sd tim giam dan ve trj sd binh thudng.
2. Su cai thien kem cua cac chi so huyet dong trong qua trinh dieu trj la yeu to tien luong nang
TAI LIEU THAM KHAO , « - . ; - • ; . • 1. Trdn Thanh Cdng, Nguyin Thi Minh Tdm, Bui Vdn Tdm (2009), "lfng dung phuang phdp he mdu lien tuc trong diiu tri sdc nhiim khudn tgi binh viin Viet Tiep Hdi Phdng", Tgp chi Yhpc Viet Nam. So 2:107-112.
2. Bui Thi Hieang Giang, Nguyin Ddng Tudn, Bui Vdn Tdm, Dgng Qudc Tudn (2009), "Ddnh gid su thay ddi cdc thdng sd huyit dpng a binh nhdn sdc nhiim khudn thai diem nhap vien bdng dng thdng Swan-Ganz ", Tgp chi Y hpc Viet Nam. Tap 359, Sd2: 4-8.
3. Hodng Vdn Quang (2009), "Nghiin cieu Miu qud he mdu liin tuc thi tich cao diiu tri suy da tgng trong sdc nhiim khudn ", Tgp chi Y hpc thuc hdnh, So 1:25-29. •, j
4. Trdn Ngpc Tudn, Nguyin Tdt Thdng, Le Ndm, Le Thi Trung (2003), "Ddnh gid sie thanh thdi cdc Cytokine
cita ky thudt he mdu lien tuc trong diiu tri binh nhdn bdng nhiim dpc nhiim khudn ndng", Tgp chi Y hpc thuc hdnh, Sd 12: 35-37.
5. De Vriese A.S., Colardyn FA., Philippe J.J., Vanholder R.C., De Sutter J.H., Lameire NH. (1999),
"Cytokine removal during continuous hemofiltration in septic patients ", J Am Soc Nephrol, 10: 846-853.
6 DellingerR.P., LevyM.M., CarletJ.M., etal (2008),
"Surviving Sepsis Campaign: International guidelines for rnanarnent of severe sepsis and septic shock", Crit
Care Med, 36:296-327.
7. John S., Griesbach D., Baumgartel M., Weihpr-echt H, Schmieder RE., Geiger H. (2001), "Effect of continuous haemofiltration vs intermittent haemodyalysis on systemic haemodynamics and
36 55 (Thang 08/2010) Y HOC LAM S A N G | 23
DIEN DAN Y HOC
Nghien CLPU khoa hoc
splanchnic regional perfusion in septic shock patients:
a prospective, randomized clinical trial", Nephrol Dial Transplant, 16: 320-327.
8. MarjanekZs., FaludiM. (2002), "Aterio- andveno- venosus hemofiltration in the treatment of sepsis and septic shock". Critical Care, 6(suppl 1): PI35.
9. Metrangolo L, Fiorilh M., Friedman G, Silance P.G., Kahn R.J, Novelli G.P, Vincent JL. (1995),
"Early hemodynamic course of septic shock", Crit Care Med, 23:1971-1975.
10. Morgera S., Shwinski T, Melzer C, Sobottke V, et al (2004), "Renal replacement therapy with high- cutoff hemofilters: Impact of convection and diffusion on cytokine clearances and protein status", Am J
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SUMMARY ^..
EVALUATION OF HEMODYAMIC EFFECTS OF CONTINUOUS VENO-VENOUS HEMOFILTRATION (CVVH) IN SEPTIC SHOCK PATIENTS
Purpose: we performed this study to evaluate the effects ofCWH on hemodyamic of septic shock patients in ICU ofBachMai Hospital Material and methods: 48 septic shock patients were treated following Surviving
hours pulse rate reduced in alive group (p < 0.001), mean blood pressure also was increased in both group (alive and death), SV of alive group was higher than that in death group but after 12 hour, mean blood Sepsis Campaign Internetional Guideline 2008 with pressure in alive group was higher in death group.
CWH. We used AN 69 filter, replacement fluid were CO, CI increased in all the patient at first day, and Hemosol or Citrate, ultrafilti-ation was 45 ml/kg/h. decreasedafter 24 hours; CVP and PCWP were stable Results: Total 48 patients 38 males and 10 females Conclusions: CWH improves the hemodyamic in at age of 60.0 ± 16.0. Only 16 patients were inserted septic shock patients. The outcome will be poor if the catheter Swan-Ganz. Effects in hemodyamic: after 6 hemodyamic not improved.
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24 I Y HOC LAM SANG S6 55 (Thang 08/2010)
