连续性静脉-静脉血液滤过联合小剂量激素对脓毒血症休克患者内皮功能的影响  

Effects of continuous veno-venous hemofiltration combined with low dose of hormone on endothelial function in septic shock

作　　者：方喜斌[1] 林浩[1] 张淇钏[1] 陈纪平[1] 

机构地区：[1]汕头市中心医院重症医学科,广东515041

出　　处：《社区医学杂志》2014年第9期9-12,共4页Journal Of Community Medicine

摘　　要：目的探讨连续静脉-静脉血液滤过（continuous venous-venous hemofiltration,CVVH）联合小剂量激素对脓毒症休克患者内皮功能的影响。方法所有患者均为2009年1月—2012年12月经临床确诊的脓毒症休克患者42例,随机分为联合组22例及病例组20例,选择同期26例在本院健康体检人员为对照组。联合组给予CVVH,加用氢化可的松每日200~300 mg加生理盐水100 ml静脉滴注,连用5 d。病例组仅给予CVVH。分别留取CVVH治疗和（或）联合小剂量激素前、入ICU第3、7天的血清,检测可溶性血栓调节蛋白（soluble thrombomodulin,sTM）、E-选择素、可溶性细胞间粘附分子-1（soluble intercellular adhesion molecule 1,SICAM-1）浓度。进行急性生理功能和慢性健康状况评分系统Ⅱ（acute physiology and chronic health evaluationⅡ,APACHEⅡ）评分评价临床疗效,对照组采血测定上述项目,做基线对比。计量资料采用t检验,P〈0.05为差异有统计学意义。结果治疗前联合组、病例组血清sTM、sICAM-1、血清E-选择素[（8.87±1.07）、（8.94±1.09）（853.64±69.82）、（858.55±63.13）、（1.36±0.23）、（1.34±0.24）ng/ml]与对照组[（3.30±0.53）、（217.58±40.05）、（0.61±0.08）ng/ml]比较差异均有统计学意义（t=23.44、23.00、39.45、42.00、15.670、25.552,均P〈0.05）;治疗第3天联合组血清sTM、sICAM-1、血清E-选择素与病例组比较差异均无统计学意义（t=-0.50、-0.69、-0.425,均P〉0.05）,治疗第7天联合组血清sTM、sICAM-1、血清E-选择素[（8.06±0.94）、（806.80±80.15）、（1.14±0.13）ng/ml]与病例组[（8.96±3.02）、（876.50±67.14）、（1.46±0.25）ng/ml]比较差异有统计学意义（t=-2.74、-3.04、-5.099,P〈0.05）。治疗前联合组APACHEⅡ评分与病例组（16.43±2.49）比较,差异无统计学意义（t=0.233,P〉0.05）;治疗第4、7天,联合组APACHEⅡ评分[（12.42±1.62）、（11.69±1.59）分]与病例组[（15.60±2.01）、Objective To study the effects of continuous venovenous hemofiltration（CVVH）combined with low dose of hormone on endothelial function in patients with septic shock.Methods 42 clinically diagnosed cases of septic shock were randomly divided into the combination group and case group from Jan.2009 to Dec.2012.Meanwhile,26 healthy subjects receiving health examina- tion were selected as control group.Combination group received CVVH,hydrocortisone,200-300 mg daily added into physical saline 100ml for intravenous administration for 5 consecutive days.Case group received CVVH only.Serums were collected before treatment,d3 and d7 after admission to ICU to determine the level of thrombomodulin （sTM）,E- selectin and intercellular adhesion molecule-l（SICAM-1）.Clinical evaluation was carried out with acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ）. Blood was also collected in 26 healthy controls and the results were taken as a baseline comparison.Measurement data were pro- cessed by t-test,the result of P〈0.05 was considered statistically significant.Results Before treatment,the levels of sTM,SICAM-1 and E- selectin were （8.87 ± 1.07）,（853.64 ± 69.82） and （1.36 ±0.23）ng/ml respectively in combination group,and （8.94 ± 1.09）, （858.55± 63.13） and（1.34± 0.24）ng/ml respectively in case group,which were significantly different from those in the con- trols [ （3.30 ± 0.53）, （217.58±40.05）, （0.61 ± 0.08）ng/ml,t=23.44,23.00,39.45,42.00,15.670,25.552,P〈0.05].On d3 after treatment, the levels of sTM,SICAM-1 and E- selectin in combination group showed no significant difference from those in case group（t=-0.50, -0.69,-0.425,P〉0.05）.On d7 after treatment,the levels of sTM,SICAM-1 and E-selectin in combination group [（8.06 ±0.94）, （806.80 ±80.15）,（1.14 ± 0.13）ng/ml] showed significant difference from those in case group[（8.96 ± 3.02）,（876.50 ± 67.14）,（1.46 ± 0.25）ng/ml]（t=-2.74,-3.04,-5.099,P〈0.05）.Before treatment,AP

关 键 词：脓毒血症休克 连续静脉静脉血液滤过 血栓调节蛋白 细胞粘附分子 E-选择素 

分 类 号：R631.1[医药卫生—外科学]