应用oXiris血液净化减轻COVID-19重症患者细胞因子风暴的治疗效果观察  

Observation of the therapeutic effect of oXiris blood purification to alleviate cytokine storm in severe COVID-19 patients

作　　者：夏莹[1] 马慧[1] 李香风[1] 王思瑶 邢宝坤[1] 杨慧[1] 赵艳伟[1] Xia Ying;Ma Hui;Li Xiangfeng;Wang Siyao;Xing Baokun;Yang Hui;Zhao Yanwei(Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院,100730

出　　处：《中华实验和临床病毒学杂志》2021年第3期335-340,共6页Chinese Journal of Experimental and Clinical Virology

摘　　要：目的探讨使用oXiris配套行血液净化治疗对新型冠状病毒肺炎(coronavirus disease-2019,COVID-19)重症患者细胞因子风暴的治疗效果观察。方法以2020年2月至4月就诊于武汉某医院重症医学科(ICU)的7例COVID-19重症患者为研究对象,采用oXiris配套进行血液净化治疗,收集患者的一般资料,血液净化治疗的基本信息,血液净化治疗前、治疗后24 h、48 h、72 h的血常规、肝肾功及炎性标志物,了解其变化趋势。结果7例患者血液净化治疗次数为2.13±1.64次,血液净化时间66.31±48.73 h;因低体温中断治疗2次。经过治疗,患者白细胞介素6(IL-6)水平由治疗前(1342.20±1822.01)pg/ml下降至(202.69±276.24)pg/ml,其中4例下降90%以上,2例下降63%及77%;肿瘤坏死因子α(TNF-α)水平由治疗前(51.94±59.64)pg/ml下降至(18.93±9.84)pg/ml,4例患者的TNF-α下降28%~78%;患者超敏C反应蛋白(hs-CRP)由治疗前(147.81±100.54)mg/L降至治疗后(89.43±108.31)mg/L,其中4例下降63%~91%。结论oXiris血液净化治疗可有效降低COVID-19重症患者的炎性标志物;治疗中正确使用oXiris滤器,可延长滤器使用时间;治疗中密切观察记录压力监测数值及管路中有无血栓形成,同时要加强保暖,预防患者低体温的发生,应用超声监测凝血及静脉血栓,对预防肺栓塞发生起到了积极的作用。Objective To observe the therapeutic effect of blood purification with oXiris on cytokine storm in severe COVID-19 patients.Methods In February to April,2020 in the intensive care unit(ICU)of a hospital in Wuhan,7 cases with severe COVID-19 as the study participant,treated with oXiris for blood purification.The general information of patients,the basic information of the blood purification treatment,blood purification treatment before and after treatment for 24 hours,48 hours,72 hours of routine blood,liver and kidney function and inflammatory markers were collected to understand the trend of change.Results The number of blood purification treatment of 7 patients were 2.13±1.64 times,and the duration of blood purification was 66.31±48.73 hours.Treatment was interrupted twice due to hypothermia.After treatment,the level of interleukin 6(IL-6)of the patients decreased from(1342.20±1822.01)pg/ml before treatment to(202.69±276.24)pg/ml in 4 cases decreased by more than 90%and in 2 cases decreased by 63%and 77%.The level of TNF decreased from 51.94±59.64 pg/ml before treatment to 18.93±9.84 pg/ml,and TNF decreased by 28%~78%in 4 patients.The hypersensitive C-reactive protein(HS-CRP)of the patients decreased from 147.81±100.54 mg/L before treatment to 89.43±108.31 mg/L after treatment,in 4 cases decreased by 63%to 91%.Conclusions oXiris blood purification treatment can effectively reduce inflammatory markers in patients with severe COVID-19.Correct use of oXiris filter during treatment can prolong the life of the filter.During the treatment,the pressure monitoring value and whether there is thrombosis in the pipeline should be closely observed and recorded.Meanwhile,it is necessary to keep patients warm to prevent hypothermia in.The application of ultrasound to monitor blood coagulation and venous thrombosis plays a positive role in preventing the occurrence of pulmonary embolism.

关 键 词：COVID-19 oXiris 血细胞因子风暴 血液净化 

分 类 号：R563.1[医药卫生—呼吸系统]