严重烧伤早期间歇性血液滤过联合血液灌流防治脓毒症的临床研究  

Clinical study on application of intermittent hemofiltration combined with hemoperfusion in the early stage of severe burn in the prevention and treatment of sepsis

作　　者：郭万里[1] 雷晋[1] 段鹏[1] 马晓明[1] 

机构地区：[1]太钢总医院山西省烧伤救治中心烧伤科,太原030009

出　　处：《中华烧伤杂志》2015年第4期248-253,共6页Chinese Journal of Burns

基　　金：山西省科技攻关项目（20110313020）

摘　　要：目的探讨严重烧伤早期应用间歇性血液滤过联合血液灌流（HP）防治脓毒症的临床效果。方法选择笔者单位2011年6月-2013年3月收治的符合入选标准的40例严重烧伤患者，采用随机数字表法分为常规治疗组和血液净化组，各20例。常规治疗组根据患者伤情按严重烧伤救治原则进行常规治疗。血液净化组患者在常规治疗基础上，于伤后3、5、7d分别行间歇性血液滤过联合HP治疗1次，每次6～8h。伤后3、5、7、10、14d，记录患者体温、心率、呼吸频率，检测白细胞计数、中性粒细胞、尿素氮、肌酐，采用ELISA法测定血清IL-1、IL-6、TNF-α、高迁移率族蛋白B1（HMGB1）水平，采用显色基质鲎试剂法检测血清LPS水平，采用双抗夹心免疫化学发光法检测血清降钙素原（PCT）水平。治疗过程中观察脓毒症发生情况。对数据行Fisher确切概率法检验、Ⅳ。检验、重复测量方差分析、LSD—t检验。结果（1）除伤后5d外，血液净化组患者其余时相点体温均明显低于常规治疗组（t值为1．87～2．97，P值均小于0．05）。伤后3～14d，血液净化组患者心率均明显慢于常规治疗组（t值为1．78～3．59，P值均小于0．05）。除伤后3d外，血液净化组患者其余时相点呼吸频率均明显慢于常规治疗组（t值为1．93—2．85，P值均小于0．05）。（2）伤后3～14d，血液净化组患者白细胞计数、中性粒细胞、尿素氮、肌酐均明显低于常规治疗组（t值为1．78～4．23，P值均小于0．05）。（3）除伤后3d外，血液净化组患者其余时相点IL．1水平均明显低于常规治疗组（t值为1．97—4．16，P值均小于0．05）。除伤后7d外，血液净化组患者其余时相点IL一6水平均明显低于常规治疗组（t值为2．11—6．34，P值均小于0．05）。伤后3～14d，血液净化组患者TNF—ol、HMGBl水平明显低于常规治疗组（t值为1，98～5．29，P�Objective To investigate the effects of application of intermittent hemofihration com- bined with hemoperfusion （HP） in the early stage of severe burn in the prevention and treatment of sepsis. Methods Forty severely burned patients, admitted to our burn ward from June 2011 to March 2013, conforming to the study criteria, were divided into conventional treatment group （ CT, n = 20） and blood purification group （BP, n = 20） according to the random number table. Patients in group CT received CT according to the accepted principles of treatment for a severe burn. Patients in group BP received CT and intermittent hemofiltration combined with HP once respectively on post injury day （PID） 3, 5, and 7, spanning 6 to 8 hours for each treatment. On PID 3, 5, 7, 10, and 14, body temperature, heart rate, and respiratory rate were recorded; white blood cell count （WBC） , neutrophil granulocytes, blood urea nitrogen （BUN）, and creatinine were determined; levels of IL-1, IL-6, TNF-α, and high-mobility group box 1 （HMGB1） in ser- um were determined by ELISA; level of LPS in serum was determined with the chromogenic substrate limulus amebocyte lysate method; level of procalcitonin （PCT） in serum was determined by double antibody sand- wich immune chemiluminescence method. The symptoms and signs of sepsis were observed during the treatment. Data were processed with Fisher＇s exact test, chi-square test, analysis of variance for repeated measurement, and LSD- t test. Results （ 1 ） Except for that on PID 5, the mean body temperature of patients in group BP was significantly lower than that of group CT at each of the rest time points （ with t values from 1.87 to 2.97, P values below 0.05 ）. The heart rate was significantly slower in patients of group BP than in group CT from PID 3 to 14 （with t values from 1.78 to 3.59, P values below 0.05 ）. Except for that on PID 3, the respiratory rate of patients in group BP was significantly slower than that of group CT at each of the rest time poin

关 键 词：烧伤 脓毒症 血液滤过 血液灌注 

分 类 号：R644[医药卫生—外科学]