全血吸附并联连续性静脉-静脉血液滤过清除血清炎症介质的效果及护理  

Effect of absorption combined with continuous venovenous hemofiltration on eliminating serum inflammatory medium and its nursing

作　　者：庄细琴[1] 朱滨[1] 丁良才[1] 王大明[1] 缪立英[2] 

机构地区：[1]苏州大学附属第三医院重症医学科,常州213003 [2]苏州大学附属第三医院血液净化中心,常州213003

出　　处：《中华现代护理杂志》2013年第26期3274-3277,共4页Chinese Journal of Modern Nursing

基　　金：江苏省常州市卫生局基金资助项目（wz201008）

摘　　要：目的 探讨全身炎症反应综合征（SIRS）患者进行全血吸附（AP）并联连续性静脉-静脉血液滤过（CVVH）清除血清炎症介质的效果和护理要点.方法 将63例SIRS患者随机分为治疗组（AP并联CVVH方法）31例和对照组（单纯CVVH方法）32例,记录患者治疗前后血清炎症介质（TNF、CRP、IL-1、IL-6和IL-10）数值并进行组内和组间统计学比较.结果 两组患者治疗前TNF、CRP、IL-1、IL-6、IL-10比较差异无统计学意义（P＞0.05）.治疗后2,26,50h治疗组TNF、CRP、IL-1、IL-6和IL-10水平呈下降趋势,与治疗前比较差异均有统计学意义（P＜0.05）.治疗后2,26,50 h对照组TNF、CRP、IL-1、IL-6和IL-10水平呈下降趋势,与治疗前比较,治疗后2h差异无统计学意义（P＞0.05）,治疗后26,50 h差异有统计学意义（P＜0.05）.治疗后相同时间点治疗组与对照组TNF、CRP、IL-1、IL-6和IL-10水平比较差异有统计学意义（P＜0.05）,如TNF,治疗后2,26,50h治疗组分别为（226.4 ±27.6）,（165.3±24.5）,（120.6±19.2）ng/L,对照组分别为（315.7±38.3）,（262.7±29.4）,（219.3±25.6） ng/L,差异均有统计学意义（t值分别为-3.31,-7.19,-8.79;P ＜0.05）.结论 AP并联CVVH能有效清除SIRS患者血清中的炎症介质.护理人员的严密监测和护理是治疗顺利进行并达到预期目标的重要环节.Objective To discuss the effect of absorption （AP） combined with continuous venovenous hemofiltration （CVVH） on eliminating serum inflammatory medium for patients with systemic inflammatory response syndrome （SIRS） and its nursing essence.Methods Totals of 63 patients with SIRS were randomly divided into the treatment group （AP combined with CWH,n =31） and the control group （CWH,n =32）.Data of serum inflammatory medium,such as TNF,CRP,IL-1,IL-6 and IL-10 were recorded and compared within and between two groups before and after the treatment.Results There was no statistically significant difference in TNF,CRP,IL-1,IL-6 and IL-10 between two groups before treatment （P ＞ 0.05）.After the treatment,levels of TNF,CRP,IL-1,IL-6 and IL-10 in 2,26 and 50 hours showed descending tendency in the treatment group,and the differences were statistically significant compared with before （P ＜ 0.05）.Levels of TNF,CRP,IL-1,IL-6 and IL-102,26 and 50 hours after the treatment in the control group also showed descending tendency,and the differences were statistically significant compared with before （P ＜ 0.05） except data in 2 hours （P ＞ 0.05）.Levels of TNF,CRP,IL-1,IL-6 and IL-10 also had statistically significant differences between two groups at the same time （P ＜ 0.05）.For example,score of TNF was respectively （226.4±27.6）,（165.3 ±24.5）,（120.6 ± 19.2） ng/L 2,26 and 50 hours after treatment in the treatment group and （315.7 ± 38.3）,（262.7 ± 29.4）,（219.3 ± 25.6） ng/L in the control group,with statistically significant differences （t =-3.31,-7.19,-8.79,respectively; P ＜ 0.05）.Condusions AP combined with CVVH can effectively eliminate the serous inflammatory medium for SIRS patients,and close surveillance and nursing are key to smooth treatment and expectations achievement.

关 键 词：护理 全身炎症反应综合征 血液滤过 吸附解毒 

分 类 号：R473.5[医药卫生—护理学]