脉冲式高容量血滤对脓毒症休克的患者临床疗效及细胞学研究  

Clinical efficacy and cytology of pulsed high volume blood filtration in patients with septic shock

作　　者：蔡荣[1] 徐洪铭 CAI Rong;XU Hongming(Department of Emergency,Yuyao People′s Hospital of Zhejiang Province,Zhejiang Province,Yuyao 315400,China)

机构地区：[1]浙江省余姚市人民医院急诊科,浙江余姚315400

出　　处：《中国医药导报》2018年第8期171-174,共4页China Medical Herald

摘　　要：目的探讨脉冲式高容量血滤对脓毒症休克的患者临床疗效及细胞学研究。方法选取2015年6月~2016年11月余姚市人民医院ICU住院的脓毒症休克患者88例,根据治疗方法不同分为对照组和观察组,每组各44例。其中对照组给予连续性血液净化治疗,观察组采用脉冲式高容量血液滤过8-16方案治疗。比较两组患者治疗前及治疗3 d后乳酸、平均动脉压(MAP)、急性生理与慢性健康评分(APACHEⅡ)评分,C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子(TNF-α),血栓调节蛋白(s TM)、血管性假血友病因子(vWF)、内皮素-1(ET-1)、E选择素(CD62E)、可溶性细胞黏附因子-1(sICAM-1)的水平变化情况。结果治疗3 d后,两组患者乳酸、APACHEⅡ评分、CRP、IL-6、TNF-α、sTM、vWF、ET-1、CD62E、sICAM-1均低于治疗前(P<0.01),MAP高于治疗前(P<0.01);其中观察组中乳酸、APACHEⅡ评分、IL-6、TNF-α、vWF、ET-1、CD62E、sICAM-1低于对照组(P<0.01),MAP高于对照组(P<0.01)。结论脉冲式高容量血滤对脓毒症休克患者具有较为肯定的临床疗效,可改善患者生命体征,可降低患者TNF-α、IL-6、CRP、vWF、ET-1、CD62E、sICAM-1的表达,对患者血管内皮细胞具有调节作用。Objective To investigate the clinical effect and cytology of pulsed high volume blood filtration in septic shock patients.Methods From June 2015 to November 2016,88 patients with septic shock in ICU of Yuyao People’s Hospital were selected.According to the different treatment methods,they were divided into control group and observation group,with 44 cases in each group.The control group was treated with continuous blood purification,and the observation group was treated with pulsed high-volume blood filtration 8-16.The levels of lactate,mean arterial pressure(MAP),acute physiology and chronic health evaluation(APACHEⅡ)score,C-reactive protein(CRP),interleukin 6(IL-6),tumor necrosis factor(TNF-α),thrombomodulin(sTM),von Willebrand factor(vWF),endothelin-1(ET-1),E-selectin(CD62E),soluble cell adhesion factor-1(sICAM-1)before and after treatment for 3 days between two groups were compared.Results After 3 days of treatment,the levels of lactate,APACHEⅡscore,CRP,IL-6,TNF-α,sTM,vWF,ET-1,CD62E,sICAM-1 were lower than those before treatment(P<0.01),the MAP higher than before treatment(P<0.01).The levels of lactate,APACHEⅡscore,IL-6,TNF-α,vWF,ET-1,CD62E,sICAM-1 in the observation group were all lower than those of control group(P<0.01),the MAP in the observation group was higher than control group(P<0.01).Conclusion Pulsed high volume blood filtration has a positive clinical effect on patients with septic shock,which can improve the vital signs of patients and reduce the levels of TNF-α,IL-6,CRP,vWF,ET-1,CD62E and sICAM-1 expression,suggesting that patients with vascular endothelial cells have a regulatory role.

关 键 词：脓毒症休克 脉冲式高容量血滤 细胞学 炎性因子 

分 类 号：R459.7[医药卫生—急诊医学]