配对血浆滤过吸附在严重脓毒症中的应用研究  

Application of coupled plasma filtration adsorption in the treatment of severe sepsis patients

作　　者：赵黎[1] 陈华茜[1] 刘巍[1] 张任[1] 孙继业[1] 曾艳[1] 赵韶静[1] 阮华玲[2] 

机构地区：[1]湖北医药学院附属东风医院肾病内科,十堰442008 [2]湖北医药学院附属东风医院内分泌科,十堰442008

出　　处：《中国血液净化》2015年第3期168-172,共5页Chinese Journal of Blood Purification

摘　　要：目的通过比较配对血浆滤过吸附(coupled plasma filtration adsorption,CPFA)和高容量血液滤过(high volume hemofiltration,HVHF)对严重脓毒症的疗效,探讨配对血浆滤过吸附治疗的优势。方法选择35例严重脓毒症患者,随机分为CPFA组(18例)和HVHF组(17例),在常规治疗的基础上分别联用CPFA治疗和HVHF治疗。观察两组治疗前和治疗10h后体温、心率、平均动脉压、多巴胺用量、氧合指数、凝血指标、血常规、肝肾功能、电解质、血糖、血乳酸、免疫球蛋白、补体、APACHEⅡ评分、TNF-α、IL-10、高迁移率簇蛋白-1(HMGB-1)、CRP的变化,同时评估两种治疗的安全性。比较2组治疗72h后的存活率。结果 2种治疗均能降低体温、心率、血肌酐、尿素氮、血乳酸、多巴胺用量、APACHEⅡ评分,升高平均动脉压、氧合指数,维持水、电解质、血糖、凝血指标稳定,2种治疗比较差异无统计学意义(P>0.05)。2种治疗对白细胞、血红蛋白、血小板、谷丙转氨酶、谷草转氨酶、胆红素、血清白蛋白、免疫球蛋白、补体均无明显影响(P>0.05)。2种治疗均能降低患者的TNF-α、IL-10、HMGB-1、CRP(P<0.05),但CPFA治疗后上述指标下降幅度大于HVHF组(t=2.374,P=0.024;t=2.074,P=0.046;t=2.066,P=0.047;t=2.562,P=0.015)。2种治疗安全,患者未出现出血、栓塞、过敏等并发症。72h后CPFA组存活14例,存活率77.8%,HVHF组存活13例,存活率76.5%,2组差异无统计学意义(χ2=0.097,P=0.756)。结论CPFA和HVHF均能安全、有效地调节严重脓毒症患者的内环境,但在降低炎症因子方面,CPFA更具优势。Objective To investigate the advantage of coupled plasma filtration adsorption（CPFA） by comparing the treatment effectiveness of CPFA and high volume hemofiltration（HVHF） in severe sepsis patients. Methods Thirty-five patients with severe sepsis were randomly divided into CPFA group（n=18） and HVHF group（n=17）. The patients received CPFA or HVHF in addition to routine therapy. Changes of the body temperature, heart rate（HR）, mean arterial pressure（MAP）, dopamine dose, oxygenation index（Pa O2/Fi O2）, coagulation indicators, blood routine, biochemical parameters of liver and kidney functions, electrolytes, blood glucose, blood lactic acid, immunoglobulin, alexin, APACHE Ⅱ score, TNF-α, IL-10, high mobility group protein-1（HMGB-1）, and CRP were compared between the 2 groups before and after the treatment for 10 hours. The safety of the two kinds of treatment was simultaneously evaluated. Survival rate was compared after the treatment for 72 hours. Results After the two therapies, body temperature, HR, serum creatinine（SCr）, BUN, blood lactic acid, dopamine dose, and APACHE Ⅱ score were significantly decreased, and MAP and Pa O2/Fi O2 were significantly increased but without statistical differences between the 2 groups（P〈0.05）. Electrolytes, acid-base balance, blood glucose and coagulation indicators all maintained in normal ranges. After the two kinds of treatment, no visible influences were found in the 2 groups in levels of white blood cell count, hemoglobin, platelet, alanine transaminase, aspartate aminotransferase, bilirubin, serum albumin,immunoglobulin, and alexin（P〈0.05）. After the two therapies, the levels of TNF- α, IL- 10, HMGB- 1, CRP were all significantly decreased（P〈0.05）, however, these changes were more evident in CPFA group than in HVHF group（t=2.374, P=0.024 for TNF-α; t=2.074, P=0.046 for IL-10;S t=2.066, P=0.047 for HMGB-1; t=2.562, P=0.015 for CRP）. The two therapies were safe, and no therapy-related adverse reactions such as hemor

关 键 词：严重脓毒症 配对血浆滤过吸附 高容量血液滤过 炎症因子 

分 类 号：R459.5[医药卫生—治疗学]