早期CVVH治疗坏死性筋膜炎并发脓毒性休克的临床研究  

The efficacy of early continuous vena-venous hemofiltration on necrotizing fasciitis complicated with septic shock

作　　者：钮柏琳[1] 杜慧敏[2] 廖锐[3] 李金正[4] 李培志[4] 

机构地区：[1]重庆医科大学附属第一医院急诊&重症医学科,400010 [2]重庆医科大学附属第一医院肿瘤科,400010 [3]重庆医科大学附属第一医院肝胆外科,400010 [4]重庆医科大学附属第二医院肝胆外科,400010

出　　处：《免疫学杂志》2016年第2期152-157,共6页Immunological Journal

基　　金：国家卫计委<国家临床重点专科-重症医学科>建设项目;国家自然科学基金(81401622;81301656)

摘　　要：目的评价早期持续静-静脉血液滤过(CVVH)在坏死性筋膜炎(NF)并发脓毒性休克中的治疗效果。方法回顾性研究坏死性筋膜炎并发脓毒性休克患者实施CVVH治疗33例,其中早期(24 h内)实施CVVH治疗15例(试验组),晚期实施CVVH治疗13例(对照组),比较2组患者2、4、6 d体内炎症指标CRP、TNF-α、IL-1、IL-6、IL-10,免疫指标淋巴细胞CD4/CD8,血流动力学指标ELWI、LAC,平均氧合指数(OI)、平均机械通气时间(MVT)、平均ICU住院日(ALST)及死亡率。结果试验组IL-1、IL-6、IL-10、ELWI、LAC水平均明显低于相应时间对照组水平,OI明显高于对照组(P<0.05);CD4/CD8值、CRP及TNF-α水平无统计学差异性(P>0.05);MVT、ALST及死亡率均明显低于对照组,有统计学意义(P<0.05)。结论 NF并发脓毒性休克早期实施CVVH治疗可降低炎性介质水平,重塑炎症与抑炎平衡,降低ELWI,改善氧合指数,缩短MVT、ALST及降低死亡率。To evaluate therapeutic the effect of early continuous vena-venous hemofiltration （CVVH） on necrotizing fasciitis （NF） complicated with septic shock, a retrospective study was carried out, which enrolled 33 cases of NF complicated with septic shock patients, including 5 cases not to accord with the inclusion criteria （rule out）, 15 cases received early CVVH therapy within 24 h after septic shock （examination group）, and 13 patients not implemented early CVVH therapy （control group）. We detected the concentration of CRP, TNF alpha, IL-1, IL-6, IL-10 in blood plasma, the lymphocyte CD4/CD8 value in blood, as well as the extravascular lung water index （ELWI）, lactic acid, average oxygen index （OI）, average time of mechanical ventilation （MVT）, average length of stay in intensive care unit （ALSI） and the mortality in the two groups at corresponding time point of the 2nd, 4th, and 6th days. Data showed that the ELWI value, MVT, ALST, mortality and the concentration levels of IL-1, IL-6, IL-10, lactic acid in examination group were significant lower than those of the control group （P〈0.05）, while the OI value of examination group was significantly higher than that of control group （P〈0.05）. The CD4/CD8 value, the concentration levels of CRP and TNF alpha showed no statistical difference between the two groups, respectively （P〉0.05）. In conclusion, The MVT, ALST of NF complicated with septic shock could be shorten and the mortality of which would be reduced via the early CVVH therapy, through the mechanism of decreasing the inflammatory cytokines concentration levels, balancing the inflammation and the anti-inflammation, eliminating the lactic acid of blood, controlling the blood volume and reducing the ELWI to improve oxygenation index.

关 键 词：坏死性筋膜炎 CVVH 脓毒性休克 炎症介质 

分 类 号：R459.7[医药卫生—急诊医学] R686.3[医药卫生—治疗学]