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1、高容量血液滤过在脓毒症治疗中的临床应用及进展王力军脓毒症是感染引起的全身炎症反应综合征，临床上证实有细菌存在或有高度可疑感染灶。其病理机制为细胞因子的瀑布样反应，导致促炎/抗炎介质之间的失衡。脓毒症进一步发展为严重脓毒症/脓毒性休克，甚至多器官功能衰竭，近年来，尽管临床医生在尝试多种治疗手段OpalSM,LaterrePF,FrancoisB,LaRosaSP,AngusDC,MiraJP,WitteboleX,DugernierT,PerrotinD,TidswellM,JaureguiL,KrellK,PachlJ,TakahashiT,Peck
2、elsenC,CordascoE,ChangCS,OeyenS,AikawaN,MaruyamaT,ScheinR,KalilAC,VanNuffelenM,LynnM,RossignolDP,GogateJ,RobertsMB,WheelerJL,VincentJL;ACCESSStudyGroup.Effectoferitoran,anantagonistofMD2-TLR4,onmortalityinpatientswithseveresepsis:theACCESSrandomizedtrial.JAMA.2013,309(11):1154-
3、62.BernardGR, FrancoisB, MiraJP, VincentJL, DellingerRP, RussellJA, LarosaSP, LaterrePF, LevyMM, DanknerW, SchmittN, LindemannJ, WitteboleX.Evaluatingtheefficacyandsafetyoftwodosesofthepolyclonalanti-tumornecrosisfactor-αfragmentantibodyAZD9773inadultpatientswithseveresepsisand
4、/orsepticshock:randomized,double-blind,placebo-controlledphaseIIbstudy.CritCareMed. 2014;42(3):504-11.，严重脓毒症患者死亡率仍高达30%~50%StevensonEK, RubensteinAR, RadinGT, WienerRS, WalkeyAJ.Twodecadesofmortalitytrendsamongpatientswithseveresepsis:acomparativemeta-analysis.CritCareMed. 2014
5、,42(3):625-31.。高容量血液滤过(Highvolumehemofiltration,HVHF)，也称高通量血液滤过，或称强化肾脏替代治疗(High-intensitycontinuousrenalreplacementtherapy)，是在常规容量血液滤过的基础上，衍生出一种新的血液净化疗法BellomoR,CassA,ColeL,FinferS,GallagherM,KimI,LeeJ,LoS,McArthurC,McGuinnessS,NortonR,MyburghJ,ScheinkestelC.Therelationshipbetw
6、eenhypophosphataemiaandoutcomesduringlow-intensityandhigh-intensitycontinuousrenalreplacementtherapy.CritCareResusc.2014;16(1):34-41.。HVHF具有清除炎症介质，维持促炎/抗炎介质间平衡、重建免疫稳态、改善氧合、血流动力学及器官功能状态、稳定内环境和降低死亡率等作用，已应用于脓毒症及多器官衰竭患者的救治RimmeléT,KellumJA.Clinicalreview:Bloodpurificationforsepsis.
7、CriticalCare.2011,15:205.。同时，HVHF治疗中亦存在诸多问题SchifflH.Thedarksideofhigh-intensityrenalreplacementtherapyofacutekidneyinjuryincriticallyillpatients.IntUrolNephrol.2010;42(2):435-40.。本文对HVHF在脓毒症患者的临床应用及进展做一综述。1.HVHF与脓毒症1.1HVHF概况1977年，Kramer等KramerP,WiggerW,RiegerJ,MatthaeiD,Scheler
8、F.Arteriovenoushaemofiltration:anewandsimplemethodfort
