翁海旭　丁张纳　徐安聪

[摘要] 目的 觀察连续静脉-静脉血液滤过（continuous veno-venous hemofiltration，CVVH）治疗脓毒性休克的临床疗效及其对血清肾素、血管紧张素Ⅱ水平的影响。 方法 对8例健康自愿者及30例脓毒性休克患者分别检测血清肾素活性及血管紧张素Ⅱ浓度，比较两组肾素活性及血管紧张素Ⅱ浓度，同时将30例脓毒性休克患者按数字随机法分成常规治疗组（A组，n=14）及常规治疗+CVVH治疗组（B组，n=16），监测治疗前后临床疗效及预后，并分别在治疗前和治疗后12 h、24 h、72 h各时间点采用放射免疫分析法检测两组患者血浆肾素活性及血管紧张素Ⅱ浓度的变化。 结果 脓毒性休克患者肾素活性及血管紧张素Ⅱ浓度明显高于健康自愿者（P<0.01），B组患者CVVH治疗后24 h及72 h肾素活性、血管紧张素Ⅱ浓度较治疗前及A组明显下降（P<0.05或P<0.01），B组ICU住院时间少于A组，B组APACHE Ⅱ评分明显优于A组（P<0.05），A组28 d存活率高于B组，但无统计学差异。结论 脓毒性休克患者使用CVVH治疗可以减少患者住院时间，改善症状，增加存活率，可能是通过清除血清内肾素、血管紧张素Ⅱ，抑制原本激活的RAS系统。

[关键词] 连续静脉-静脉血液滤过；脓毒性休克；肾素；血管紧张素Ⅱ

[中图分类号] R459.5 [文献标识码] A [文章编号] 1673-9701（2018）20-0018-04

Effect of continuous veno-venous hemofiltration on serum renin， angiotensin Ⅱ and prognosis in patients with septic shock

WENG Haixu DING Zhangna XU Ancong LI Buwu LUO Wenchao HE Guoxin YE Huanle

Department of Intensive Care Therapy， the Third Affiliated Hospital of Wenzhou Medical University， Wenzhou 325200， China

[Abstract] Objective To observe the clinical effect of continuous veno-venous hemofiltration（CVVH） on patients with septic shock and its effect on serum renin and angiotensin Ⅱ. Methods Serum renin activity and angiotensin Ⅱ concentration were measured in 8 healthy volunteers and 30 septic shock patients. The renin activity and angiotensin Ⅱ concentration were compared between the two groups. Thirty patients with septic shock were divided into the following two groups according to random number method， routine treatment group（n=14 in group A） and routine treatment+CVVH treatment group （n=16 in group B）. The clinical efficacy and prognosis were monitored before and after treatment. The plasma renin activity and the concentration of angiotensin Ⅱ in the two groups were measured by radioimmunoassay at 12 h，24 h and 72 h. Results The renin activity and the concentration of angiotensin Ⅱ were significantly higher in patients with septic shock than those in healthy volunteers（P<0.01）. The activity of renin and the concentration of angiotensin Ⅱ at 24 h and 72 h in group B were significantly higher than those before treatment and also higher than those in group A（P<0.05 or P<0.01）. The hospitalization time of ICU in group B was less than that of group A. The APACHE Ⅱ score of group B was significantly better than that of group A（P<0.05）. The 28-day survival rate of group A was higher than that of group B while there was no statistical difference. Conclusion CVVH treatment in patients with septic shock can reduce hospitalization time， improve symptoms and increase survival rate. It may work by the elimination of serum renin and angiotensin Ⅱ and inhibition of the originally activated RAS system.

[Key words] Continuous veno-venous hemofiltration； Septic shock； Renin； Angiotensin Ⅱ

脓毒症及脓毒性休克是当前重要的医学问题，虽然诊治措施、监护手段逐年提高，但其发病率和死亡率仍居高不下[1，2]。脓毒性休克患者血压下降触发复杂的神经-体液调节机制，尤其肾素-血管紧张素-醛固酮系统（renin-angiotensin-aldosterone system，RAAS）的激活是维持容量和血管张力的重要机制，但血管紧张素Ⅱ具有促炎效果，血管紧张素Ⅱ水平的升高与脏器功能衰竭、死亡率密切相关[3]。目前多项研究表明，连续静脉-静脉血液滤过（CVVH）具有清除炎症介质、平衡电解质、稳定内环境等作用，是治疗脓毒性休克的有效手段。本研究获医院伦理委员会审批，采用随机对照方法，观察脓毒性休克患者联合CVVH治疗前后不同时相……