血液净化对脓毒性休克患者血清细胞因子及预后的影响  

Influence of blood purification on serum cytokine levels and prognosis in patients with septic shock

作　　者：何盛琴[1] 熊建琼[1] 屈纪富[1] 张雷[1] 王涛[1] 张永辉[1] 张彦[1] 陈琨[1] 

机构地区：[1]第三军医大学西南医院急救部,重庆400038

出　　处：《第三军医大学学报》2011年第10期1061-1064,共4页Journal of Third Military Medical University

基　　金：第三军医大学西南医院院管课题(2008XG19)~~

摘　　要：目的研究不同血液净化方式对脓毒性休克患者血清细胞因子水平及预后的影响,探讨血液净化对脓毒性休克患者的治疗作用。方法将36例急性生理及慢性健康评分Ⅱ(APACHEⅡ评分)≥15分的脓毒性休克患者,采用随机数字表法分为对照组、连续性静脉-静脉血液滤过(continuous veno-venous hemofiltration,CVVH)组、血液灌流(hemoper-fusion,HP)+连续性静脉-静脉血液滤过组(HP+CVVH),每组12例,分别进行常规治疗、常规治疗+CVVH治疗、常规治疗+HP+CVVH治疗。检测各组治疗后不同时相点血清TNF-α、IL-6、IL-10、HMGB-1浓度,并比较各组1～7 d全身性感染相关性器官功能衰竭评价(sepsis related organ failure assessment,SOFA)评分及28 d存活率的差别。结果对照组及CVVH组TNF-α、IL-6、HMGB-1、IL-10在第1、3天各时相点浓度变化均无统计学意义(P>0.05);HP+CVVH组中HP治疗2 h后的TNF-α、HMGB-1、IL-10均有明显下降,IL-6也有一定下降,其他时相点浓度变化均无统计学意义(P>0.05)。与对照组相比,CVVH组从第4天起SOFA评分即明显降低(P<0.05),HP+CVVH组第2天起SOFA评分即明显降低(P<0.05);28 d存活率提高(对照组、CVVH组、HP+CVVH组分别为41.67%、58.33%、66.67%),且以HP+CVVH组更明显,但3组间无统计学意义。结论 CVVH对脓毒性休克患者血清TNF-α、IL-6、HMGB-1、IL-10的水平无明显影响,HP能显著降低血清TNF-α、HMGB-1、IL-10浓度;CVVH及HP+CVVH治疗均能促进脓毒性休克患者器官功能恢复,且以HP+CVVH治疗效果更佳。Objective To investigate the influence of different blood purification methods on serum cytokine levels and prognosis in patients with septic shock,and to study the therapeutic effects of different blood purification methods on the patients.Methods Thirty-six septic shock patients with acute physiology and chronic health evaluation II（APACHEII） scores not smaller than 15 were randomly divided into a control group（C group）,a continuous veno-venous hemofiltration group（CVVH group）,and a hemoperfusion and continuous veno-venous hemofiltration group（HP＋CVVH group）.The C group underwent conventional therapy.The CVVH group underwent conventional therapy and CVVH therapy.The HP＋CVVH group underwent conventional therapy,HP therapy,and CVVH therapy.The levels of serum cytokines including tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）,interleukin-10（IL-10）,and high-mobility group box chromosomal protein-1（HMGB-1） in each group were measured at different time points after treatment.The survival rates for 28 d and sepsis related organ failure assessment（SOFA） scores at 1 to 7 d of the three groups were compared.Results There was no significant change in the levels of serum TNF-α,IL-6,IL-10,and HMGB-1 at different time points in the first day and the third day in the C group and CVVH group（P0.05）.The levels of TNF-α,IL-10,and HMGB-1 significantly decreased 2 h after HP treatment in the HP＋CVVH group,and the IL-6 level also decreased.There was no significant difference in the levels of TNF-α,IL-6,IL-10,and HMGB-1 at other times in the HP ＋ CVVH group（P0.05）.Compared with the C group,SOFA score started to significantly decrease on the fourth day in the CVVH group（P0.05） and on the second day in the HP＋CVVH group（P0.05）.The survival rates for 28 d increased in the three groups（41.67% vs 58.33% vs 66.67%）,especially in the HP＋CVVH group,without statistical significance among the three groups.Conclusion There is no significant influence of CVVH on the lev

关 键 词：血液灌流 血液滤过 脓毒性休克 细胞因子 预后 

分 类 号：R631.4[医药卫生—外科学] R459.5[医药卫生—临床医学]