连续血液净化对脓毒症患者的IL-6、TNF-α及PCT水平的影响  

Efficacy of Continuous Blood Purification Therapy on Patients with Sepsis and Effect on IL-6,TNF-α and PCT Levels

作　　者：钟俊 杨国辉[2] ZHONG Jun;YANG Guohui(ICU,Guihang Guiyang Hospital,Guiyang 550009,Guizhou,China;MICU,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China)

机构地区：[1]贵航贵阳医院重症医学科,贵州贵阳550009 [2]贵州医科大学附院内科ICU,贵州贵阳550004

出　　处：《贵州医科大学学报》2018年第11期1328-1331,共4页Journal of Guizhou Medical University

基　　金：贵州省优秀科技教育人才省长专项基金[黔省专合字(2009)43号]

摘　　要：目的:探讨连续血液净化(CPB)对脓毒症患者的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及降钙素原(PCT)水平的影响及疗效。方法:75例脓毒症患者,根据治疗方式均分为CPB组(连续血液净化治疗72 h)、IHD组(间断血液透析治疗、8 h/d、共3 d)及对照组(未进行血液净化治疗),分别于治疗前及治疗72 h时检测3组患者血清IL-6、TNF-α及PCT水平,比较治疗72 h时3组患者的机械通气时间、住院时间及住院28 d时的存活率。结果:治疗前,3组患者血清IL-6、TNF-α及PCT水平比较,差异无统计学意义(P> 0. 05);治疗72 h时,CPB组、IHD组血清IL-6、TNF-α及PCT水平低于对照组及同组治疗前(P <0. 05);治疗72 h时,CPB组机械通气时间、住院时间较IHD组及对照组缩短(P <0. 05); CPB组28 d住院存活率明显高于IHD组及对照组(P <0. 05)。结论:CPB能有效提高脓毒症患者的存活率,其机制可能与CPB清除血液炎症介质有关。Objective：To investigate the clinical efficacy of continuous blood purification in the treatment for sepsis patients and the effect on level of IL-6, TNF-α and PCT. Methods： 75 cases of sepsis patients were divided into continuous hemodialysis group （72 continuous hours）, intermittent hemodialysis group （8 hours a day for 3 days）, and control groups （no blood purification treatment）. For all groups, interleukin-6 （IL-6）, tumor necrosis factor-α （TNF-α） and procalcitonin （PCT） level were detected before and 72 hr after treatment. Mechanical ventilation time of all patients after 72 hr treatment, hospitalized time and survival rate after 28 days after admission. Results： Before treatment, comparison of serum PCT, IL-6 and TNF-α levels of all patients showed no statistical significance （ P 〉0.05） ; 72 hr after treatment, serum IL-6, TNF-α and PCT level of CPB and IHD group were lower than that of control group and before treatment level （ P 〈0.05）; mechanical ventilation time and hospitalization time of CPB group were shortened than that of IHD and control group （ P 〈0.05）; survival rate after 28 days of admission of CPB group was significantly higher than the other two groups （ P 〈0.05）. Conclusion： Continuous blood purification can effectively improve survival rate of sepsis patients, its mechanism might involving remove inflammatory mediators.

关 键 词：脓毒症 连续血液净化 血液透析 炎性因子 存活率 治疗效果 白细胞介素-6 肿瘤坏死因子-Α 

分 类 号：R459.7[医药卫生—急诊医学]