持续低效血液透析联合血液灌流治疗多脏器功能障碍综合征患者的疗效观察  

Efficacy of sustained low-efficiency dialysis combined with hemoperfusion in patients with multiple organ dysfunction syndrome

作　　者：黄欢[1] 许标[1] 罗玮[1] HUANG Huan;XU Biao;LUO Wei(Department of Physician,Guangning Vounty People’s Hospital,Zhaoqin,526300)

机构地区：[1]广东省肇庆市广宁县人民医院,526300

出　　处：《中国实用医药》2020年第5期1-4,共4页China Practical Medicine

基　　金：2017年广东省肇庆市科技创新指导类项目(项目编号:201704030715)。

摘　　要：目的观察持续低效血液透析(SLED)联合血液灌流(HP)对多脏器功能障碍综合征(MODS)患者的炎症水平及预后的影响,评价其疗效。方法72例MODS患者,根据所采用的血液净化方法不同分为SLED组(给予SLED治疗)、SLED+HP组(给予SLED+HP治疗)、持续静脉-静脉血液滤过(CRRT)组(给予CRRT治疗)、CRRT+HP组(给予CRRT+HP治疗),各18例。比较四组患者治疗前和治疗后的急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、血清肌酐(Scr)、超敏C反应蛋白(hs-CRP)、白介素(IL)-6、IL-10、肿瘤坏死因子-α(TNF-α)水平,治疗后28 d存活率。结果治疗后,四组患者的APACHEⅡ评分、Scr、hs-CRP、IL-6、IL-10、TNF-α水平均显著降低,差异有统计学意义(P<0.05)。SLED+HP组的APACHEⅡ评分、Scr、hs-CRP、IL-6、IL-10、TNF-α水平降低大于SLED组,CRRT+HP组的APACHEⅡ评分、Scr、hs-CRP、IL-6、IL-10、TNF-α水平降低大于CRRT组,差异均有统计学意义(P<0.05)。SLED+HP组和CRRT+HP组、SLED组和CRRT组比较差异无统计学意义(P>0.05)。SLED+HP组的28 d存活率为88.9%,CRRT+HP组的28 d存活率为83.3%,均高于SLED组的55.6%与CRRT组的50.0%,差异有统计学意义(P<0.05)。SLED+HP组与CRRT+HP组、SLED组和CRRT组患者的28 d存活率比较,差异无统计学意义(P>0.05)。结论四种血液净化治疗方案均能有效降低MODS患者的血清Scr、hs-CRP、IL-6、IL-10、TNF-α水平,改善患者临床症状和体征。SLED联合HP具有更强的清除炎症因子能力和肾功能保护作用,能改善患者的预后,其治疗效果与CRRT联合HP相当。Objective To observe the effect of sustained low-efficiency dialysis(SLED)combined with hemoperfusion(HP)in patients with multiple organ dysfunction syndrome(MODS),and evaluate its efficacy.Methods A total of 72 MODS patients were divided into sustained low-efficiency dialysis group(SLED),sustained low-efficiency dialysis combined with hemoperfusion group(SLED+HP group),continuous renal replacement therapy group(CRRT group)and continuous renal replacement therapy combined with hemoperfusion group(CRRT+HP group),with 18 cases in each group.The Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,serum creatinine(Scr),hypersensitive C-reactive protein(hs-CRP),interleukin(IL)-6,IL-10,tumor necrosis factorα(TNF-α)before treatment and after treatment,occurrence of complications and survival rate after 28 d of treatment were compared among the four groups.Results After treatment,the APACHEⅡscore,serum Scr,hs-CRP,IL-6,IL-10 and TNF-αlevels in four groups were decreased than those before treatment,and their difference was statistically significant(P<0.05).The degree of reduction of APACHEⅡscore,serum Scr,hs-CRP,IL-6,IL-10 and TNF-αlevels in SLED+HP group was greater than those in SLED group,and CRRT+HP group was greater than CRRT group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in APACHEⅡscore,serum Scr,hs-CRP,IL-6,IL-10 and TNF-αlevels between SLED+HP group and CRRT+HP group(P>0.05).The 28 d survival rate was 88.9%in SLED+HP group and 83.3%in CRRT+HP group,which were higher than 55.6%in SLED group and 50.0%in CRRT group,and their difference was statistically significant(P<0.05).There was no statistically significant difference in 28 d survival rate between SLED+HP group and CRRT+HP group(P>0.05).Conclusion Four kinds of blood purification therapy can effectively reduce the levels of serum Scr,hs-CRP,IL-6,IL-10,TNF-α,and improve the clinical symptoms and signs of MODS patients.SLED combined with hemoperfusion has a stronger ability t

关 键 词：持续低效血液透析 连续肾脏替代治疗 血液灌流 多脏器功能障碍综合征 

分 类 号：R459.7[医药卫生—急诊医学]