血液灌流对因腹腔感染所致感染性休克患者临床疗效及预后的影响  

Effect of hemoperfusion on clinical efficacy and prognosis in patients with abdominal septic shock

作　　者：刘星[1] 杨铁成 王华侨 王昕[3] 杨丽洁 王丹雯 饶歆[1] Liu Xing;Yang Tiecheng;Wang Huaqiao;Wang Xin;Yang Lijie;Wang Danwen;Rao Xin(Intensive Care Unit,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Gastrointestinal Surgery,Zhongnan Hospital of Wuhan University,Clinical Medical Research Center of Peritoneal Cancer of Wuhan,Clinical Cancer Study Center of Hubei Provence,Key Laboratory of Tumor Biological Behavior of Hubei Provence,Wuhan 430071,China;Department of Gastrointestinal Surgery,Tongcheng People’s Hospital,Tongcheng 437400,China)

机构地区：[1]武汉大学中南医院重症医学科,430071 [2]武汉大学中南医院胃肠外科武汉市腹膜癌临床医学研究中心湖北省肿瘤医学临床研究中心肿瘤生物学行为湖北省重点实验室,430071 [3]通城县人民医院胃肠外科,湖北通城437400

出　　处：《中华实验外科杂志》2019年第9期1650-1653,共4页Chinese Journal of Experimental Surgery

基　　金：国家自然科学基金资助项目(81770283);武汉市腹膜癌临床医学研究中心资助项目(2015060911020462);湖北省卫生与计划生育委员会科研基金资助项目(WJ2017M249).

摘　　要：目的观察血液灌流在腹腔感染所致感染性休克患者中的临床疗效和对预后的影响.方法选自因腹腔感染所致感染性休克由武汉大学中南医院胃肠外科转入重症医学科继续治疗的住院患者63例,分为治疗组28例和对照组35例,治疗组在常规治疗的基础上接受血液灌流治疗,对照组只进行常规治疗.两组患者分别于治疗前、治疗12h和36 h评估急性生理功能及慢性健康状况评分系统Ⅱ(APACHEⅡ)和序贯器官衰竭评分(SOFA),监测患者平均动脉压所需使用的去甲肾上腺素用量(NOR/MAP)、血乳酸水平、降钙素原(PCT)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-oα),并比较两组患者重症监护病房(ICU)住院时长和28 d死亡率.采用SPSS 20.0统计软件分析,计量资料采用均值±标准差(Mean±SD)表示,两个独立样本间比较采用t检验,两个独立样本间率的比较采用x^2检验,多个独立样本间比较采用方差分析.结果所有纳入患者的基础情况(年龄、性别、APACHEⅡ评分、SOFA评分和致病菌构成等)比较,差异无统计学意义(P>0.05).与治疗前比较,两组患者在治疗36 h时间点,其APACHEⅡ评分、SOFA评分、NOR/MAP、血乳酸、PCT、IL-6和TNF-α水平均有显著下降(t=5.269、2.715、3.058、1.937、4.411、3.163、3.761、2.553、2.817、2.473、4.871、5.066、3.994、2.532,P<0.05);与对照组比较,治疗组患者在治疗36 h时间点的APACHEⅡ评分、NOR/MAP、PCT、IL-6和TNF-α水平均明显降低(t=2.077、2.321、2.659、3.336、2.088,P<0.05).治疗组患者ICU住院时长为(10.6±4.0)d,与对照组[(13.1±4.2)d]比较,治疗组患者ICU住院时长明显缩短(t=2.725,P<0.05);而两组患者28 d死亡率比较差异无统计学意义(x^2=0.171,P>0.05).结论血液灌流能降低因腹腔感染所致感染性休克患者APACHEⅡ评分,改善血流动力学,降低PCT及炎性介质IL-6和TNF-α水平,缩短ICU住院时长,而对28 d死亡率无影响.Objective To explore the effect of hemoperfusion on clinical efficacy and prognosis in patients with septic shock caused by abdominal infection.Methods Sixty-three hospitalized patients with septic shock caused by abdominal infection transferred from Department of Gastrointestinal Surgery to Intensive Care Unit(ICU)of Zhongnan Hospital of Wuhan University from June 2018 to November 2018 were enrolled and divided into two groups.Patients of treatment group(n=28)were treated with hemoperfusion therapy in addition to conventional therapy,while patients of control group(n=35)only received conventional therapy.Clinical data including APACHEⅡscore,SOFA score,the demand for norepinephrine to achieve a certain mean arterial pressure(NOR/MAP),blood lactate level,procalcitonin(PCT),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were measured at different time points in each group during the treatment.The duration of ICU stay and 28-day mortality were compared between the two groups.Results There was no significant difference in basic condition(including a variety of clinical factors,such as age,gender,APACHEⅡscore,SOFA score and pathogenic bacteria composition,etc.)among all included patients(P>0.05).At 36 h after the initiation of treatment,the APACHEⅡscore,SOFA score,NOR/MAP,blood lactate,PCT,IL-6 and TNF-αlevels decreased significantly in both groups(t=5.269,2.715,3.058,1.937,4.411,3.163,3.761,2.553,2.817,2.473,4.871,5.066,3.994,2.532,P<0.05);in the treatment group,the APACHEⅡscore,NOR/MAP,PCT,IL-6 and TNF-αlevels obviously decreased at 36 h compared with the control group(t=2.077,2.321,2.659,3.336,2.088,P<0.05).The duration of ICU stay in the treatment group was(10.6±4.0)d,which was obviously shorter than that in the control group(t=2.725,P<0.05),but there was no significant difference in the 28-day mortality between the two groups(χ^2=0.171,P>0.05).Conclusion Hemoperfusion can improve APACHEⅡscore and hemodynamics,reduce the levels of PCT,IL-6 and TNF-α,shorten the duration of ICU stay,but has n

关 键 词：血液灌流 脓毒症 腹腔感染 感染性休克 炎性介质 血流动力学 

分 类 号：R459.7[医药卫生—急诊医学]