持续静脉-静脉血液滤过联合血液灌流在重症脓毒血症患者治疗中对炎性因子及器官功能的影响  

Effect of continuous veno venous hemofiltration combined with hemoperfusion on inflammation and organ function in the treatment of severe sepsis

作　　者：郑文娟[1] 斯小水[1] 何建新[1] 季明霞[1] 黄静[1] 王娇[1] 陈梦燕[1] 王俊峰[1] 

机构地区：[1]义乌市中心医院重症医学科,浙江义乌322000

出　　处：《全科医学临床与教育》2014年第6期619-622,共4页Clinical Education of General Practice

摘　　要：目的研究持续静脉-静脉血液滤过(CVVH)联合血液灌流治疗对炎性因子及器官功能的影响。方法将重症脓毒血症患者81例随机分为观察组41例和对照组40例,对照组给予常规治疗方法及CVVH治疗,观察组在对照组治疗基础上给予血液灌流治疗。观察两组患者治疗前后生命体征、炎症因子水平、脏器功能及急性生理学与慢性健康状况(APACHEⅡ)评分和全身性感染相关性器官功能衰竭(SOFA)评分的变化。结果两组治疗后呼吸、心率均低于治疗前,平均动脉压高于治疗前,差异均有统计学意义(t分别=7.99、11.81、9.43;4.77、4.04、5.33;P均<0.05),且观察组治疗后优于对照组治疗后,差异均有统计学意义(t分别=15.99、15.81、4.43,P均<0.05)。两组治疗后肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-10、丙氨酸氨基转移酶(ALT)、血肌酐(SCR)水平,以及APACHEⅡ评分、SOFA评分均低于治疗前,差异均有统计学意义(t分别=6.79、13.84、12.41、12.29、14.48、21.41、13.33;7.67、7.04、10.39、7.03、7.77、12.39、12.21,P均<0.05);且观察组治疗后低于对照组治疗后,差异均有统计学意义(t分别=30.89、25.11、14.93、26.11、20.89、13.66、14.93,P均<0.05)。结论 CVVH联合血液灌流可有效清除重症脓毒血症患者血液中多种炎性介质,有助于脏器功能的保护。Objective To research the effect of continuous veno venous hemofiltration （CVVH） combined with hemoperfusion on inflammation and organ function in the treatment of severe sepsis. Methods A total of 81 patients with severe sepsis were randomly divided into the observation group（41 cases） and control group （40 cases）.The control group was given conventional treatment and CVVH treatment while the observation group was given hemoperfusion additionally on the basis of control group. The vital signs, levels of inflammation, organ function, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） and sepsis related organ failure assessment （SOFA） between two groups were observed and compared. Results The breathing rate and heart rate of two groups at posttreatment were significantly lower than priori treatment while the mean arterial pressure were significantly higher （t=7.99,11.81,9.43;4.77,4.04,5.33,P〈0.05）. The breathing rate, heart rate and mean arterial pressure of two groups at posttreatment were statistically different （t=15.99,15.81,4.43,P〈0.05）.The TNF-α, IL-6, IL-10, ALT, SCR, APACHEⅡscore and SOFA score of two groups at posttreatment were significantly lower than priori treatment（t=6.79,13.84,12.41,12.29,14.48,21.41,13.33;7.67,7.04,10.39, 7.03,7.77,12.39,12.21,P〈0.05）as well as compared observation group with control group at posttreatment（t=30.89,25.11, 14.93,26.11,20.89,13.66,14.93,P〈0.05）. Conclusion CVVH combined with hemoperfusion can effectively remove various inflammatory mediators in the blood and contribute to the protection of organ function.

关 键 词：血液灌流 持续静脉-静脉血液滤过 脓毒血症 炎性因子 

分 类 号：R459.7[医药卫生—急诊医学]