| 全军承,周人杰,郑晖,等.组合式血液净化治疗脓毒症所致多脏器功能障碍综合征的临床研究[J].安徽医药,2021,25(9):1816-1821. |
| 组合式血液净化治疗脓毒症所致多脏器功能障碍综合征的临床研究 |
| Clinical study of combined blood purification in the treatment of multiple organ dysfunction syndrome induced by sepsis |
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| DOI：10.3969/j.issn.1009-6469.2021.09.028 |
| 中文关键词: 脓毒症 多脏器功能障碍综合征 血液滤过 血浆置换 血液灌注 吸附 组合式血液净化 炎性因子 血流动力学 免疫功能 |
| 英文关键词: Sepsis Multiple organ dysfunction syndrome Hemofiltration Plasma exchange Hemoperfusion Adsorption Combined blood purification Inflammatory factor Hemodynamics |
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| 中文摘要: |
| 目的探讨组合式血液净化对脓毒症所致多脏器功能障碍综合征( MODS)病人血清炎性因子、血流动力学及免疫功能的影响。方法采用前瞻性随机对照的研究方法，选取 2017年 11月至 2019年 11月就诊于陆军军医大学第二附属医院的符合纳排标准的脓毒症所致 MODS病人为研究对象，采用随机数字表法将病人分为对照组及观察组，两组拟纳入病人各 40例。对照组给予病人连续性静脉 -静脉滤过( CVVH)治疗，观察组病人采用组合式血液净化治疗:单纯 CVVH，CVVH＋血浆置换， CVVH＋胆红素吸附( bilirubin adsorption，BS)。收集病人入院时生命体征外周静脉血中的血清炎性因子水平及免疫功能指标，血流动力学指标，采用两独立样本 t检验的统计方法比较两组间治疗前后上述指标变化情况。结果治疗后观察组心率、 MODS评分及急性生理学和慢性健康状况评价 Ⅱ(APACHE Ⅱ)评分低于对照组( P<0.05)，平均动脉压( MAP)显著高于对照组(P<0.05)；治疗后观察组的白细胞介素 -8(IL-8)、肿瘤坏死因子 -α(TNF-α)白细胞介素 -6(IL-6)水平显著低于对照组［(502.53±12.21)ng/L比( 523.67±14.28)ng/L、(75.60±8.21)ng/L比( 80.45±6.38)ng/L257.10±8.24)ng/L比( 286.33±6.12)ng/L］(均 P<0.05)；治疗后观察组的胸腔内血容量指数( ITBVI)、血管外肺水指数( EVLWI)水平显著低于对照组( P<0.05)；治疗后观察组免疫球蛋白 A(IgA)(1.85±0.41)g/L、免疫球蛋白 G( IgG)(14.32±2.89)g/L、免疫球蛋白 M( IgM)(1.45±0.33)g/L、CD4+(38.86±4.41)%及 CD4+/CD8(+1.43±0.25)显著高于对照组( 1.51±0.28)g/L、(8.91±2.50)g/L、(1.17±0.23)g/L、(36.08±4.06)%、(1.24±0.21)(P<0.05)， (21.59±3.05)%显著低于对照组( 24.69±3.13)%(P<0.05)。结论组合式血液净化清除脓CD8+与单一 CVVH相比，毒症所致 MODS病人炎性因子的能力更强，具有更好的稳定性，能更好地调节免疫功能指标。 |
| 英文摘要: |
| Objective To explore the effect of combined blood purification on serum inflammatory factors, hemodynamics and immune function in patients with sepsis-induced multiple organ dysfunction syndrome (MODS).Methods Using a prospective randomized case-control study, 80 patients with sepsis complicated with MODS who met with arrangement standards admitted to The SecondAffiliated Hospital of Army Military Medical University from November 2017 to November 2019 were selected as study subjects. Thepatients were assigned into study group and control group with 40 patients in each group. The control group underwent continuous venovenous hemofiltration (CVVH) therapy, while the study group underwent combined blood purification therapy: CVVH alone, CVVH +plasma exchange, CVVH + bilirubin adsorption (BS). Level of serum inflammatory factor in peripheral venous blood of patients at admission, immune function index, and hemodynamic index were collected, and the changes of these indexes before and after treatmentwere compared between the two groups using two-sample t test.Results After treatment, the heart rate (HR), MODS score and acutephysiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score of the study group were significantly lower than those of the controlgroup (P<0.05), and the mean arterial pressure (MAP) was significantly higher than that of the control group (P<0.05). After treatment, the levels of interleukin-8 (IL-8), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) of the study group were significantly lower than those of the control group [(502.53±12.21) ng/L vs. (523.67±14.28) ng/L, (75.60±8.21) ng/L vs. (80.45±6.38) ng/L, (257.10±8.24) ng/L vs. (286.33±6.12) ng/L] (all P<0.05). After treatment, the intrathoracic blood volume index (ITBVI) and extravascular lung waterindex (EVLWI) in the study group were significantly lower than those in the control group (P<0.05). After treatment, the levels of immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM), CD4+ and CD4+/CD8+ ratio in the study group were significantly higher than those in control group [(1.85±0.41) g/L vs. (1.51±0.28) g/L, (14.32±2.89) g/L vs. (8.91±2.50) g/L, (1.45±0.33) g/L vs. (1.17±0.23) g/L, (38.86±4.41) % vs. (36.08±4.06) %, (1.43±0.25) vs. (1.24±0.21), respectively; P<0.05]. CD8 in the study group was significantly lower than that in the control group [(21.59±3.05) % vs. (24.69±3.13) % , P<0.05].Conclusion In comparison with singleCVVH, combined blood purification showed better capacity in removing inflammatory factors in MODS patients with sepsis, which hasbetter stability, and can better regulate immune function indicators. |
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