配对血浆滤过吸附与连续性静脉-静脉血液滤过治疗脓毒性休克并发急性呼吸窘迫综合征疗效比较  

Comparison of the effect of coupled plasma filtration adsorption and continuous veno-venous hemofiltration in the treatment of patients with septic shock and acute respiratory distress syndrome

作　　者：明月 许瑞涛 晁琳琳 李双凤 李晓燕 张瑞霞 张磊 张根生[3] 高延秋 MING Yue;XU Ruitao;CHAO Linlin;LI Shuangfeng;LI Xiaoyan;ZHANG Ruixia;ZHANG Lei;ZHANG Gensheng;GAO Yanqiu(Xinxiang Medical University,Xinxiang 453003,Henan Province,China;Respiratory Intensive Care Unit,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450002,Henan Province,China;Department of Critical Care Medicine,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,Zhejiang Province,China)

机构地区：[1]新乡医学院,河南新乡453003 [2]郑州大学附属郑州中心医院呼吸重症医学科,河南郑州450002 [3]浙江大学医学院附属第二医院重症医学科,浙江杭州310009

出　　处：《新乡医学院学报》2021年第11期1029-1036,共8页Journal of Xinxiang Medical University

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20200772);河南省科技攻关项目(编号:182102310177)。

摘　　要：目的比较配对血浆滤过吸附(CPFA)与连续性静脉-静脉血液滤过(CVVH)治疗脓毒性休克并发急性呼吸窘迫综合征(ARDS)的临床效果,探讨CPFA在脓毒性休克并发ARDS患者中的应用价值。方法选择2018年1月至2020年12月郑州大学附属郑州中心医院呼吸重症监护室(RICU)收治的60例脓毒性休克并发ARDS患者为研究对象,根据血液净化模式将患者分为CVVH组和CPFA组,每组30例。分别于治疗前及治疗后第1、2、3天检测2组患者血清C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平;分别于治疗前及治疗后第1、2、3、7天检测2组患者动脉血乳酸(LAC)水平,并测量收缩压及舒张压,计算平均动脉压(MAP);分别于治疗前及治疗后第3、7天检测2组患者淋巴细胞(LY)及T淋巴细胞亚群CD3^(+)、CD4^(+)、CD8^(+)水平,并测定动脉血氧分压,计算CD4^(+)/CD8^(+)、氧合指数;分别于治疗前及治疗后第3、7天对2组患者进行序贯器官衰竭(SOFA)评分;分别于治疗前及治疗后第1、2、3、7天检测2组患者红细胞(RBC)、白细胞(WBC)及血小板(PLT)水平;记录2组患者RICU机械通气时间、RICU住院时间、去甲肾上腺素(NE)应用情况及28 d生存率。结果治疗前2组患者血清PCT、CRP、IL-6、IL-10及TNF-α水平比较差异无统计学意义(P>0.05);2组患者治疗后第1、2、3天血清PCT、CRP、IL-6、IL-10及TNF-α水平均呈下降趋势(P<0.05),CPFA组患者血清IL-6、IL-10、TNF-α水平降低程度大于CVVH组(P<0.05);治疗后第1、2、3天,CPFA组患者血清IL-10水平显著低于CVVH组(P<0.05);治疗后第1、2天,CPFA组患者血清IL-6、TNF-α水平显著低于CVVH组(P<0.05);治疗后第1、2、3天,2组患者血清CRP、PCT水平比较差异无统计学意义(P>0.05)。治疗前2组患者MAP及动脉血LAC水平比较差异无统计学意义(P>0.05);2组患者治疗后1、2、3、7天MAP呈上升趋势,动脉血LAC水平呈下�Objective To investigate the clinical value of coupled plasma filtration adsorption(CPFA)by comparing the clinical efficacy of CPFA and continuous veno-venous hemofiltration(CVVH)in patients with septic shock and acute respiratory distress syndrome(ARDS).Methods Sixty patients with septic shock and ARDS received in the respiratory intensive care unit(RICU)of Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2018 to December 2020 were selected as the research subjects.The patients were divided into CVVH group and CPFA group according to the blood purification mode,with 30 cases in each group.The levels of serum C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)in the two groups were detected before treatment and on the 1^(st),2^(nd),3^(rd) day after treatment.The level of arterial blood lactic acid(LAC)were detected before treatment and on the 1^(st),2^(nd),3^(rd),7^(th) day after treatment;meanwhile,the systolic and diastolic blood pressure were measured,and the mean arterial pressure(MAP)was calculated.The levels of lymphocyte(LY)and T-lymphocytes subgroups(CD3^(+),CD4^(+),CD8^(+))in the two groups were detected before treatment and on the 3^(rd),7^(th) day after treatment;meanwhile,the arterial partial pressure of oxygen was measured,and oxygenation index and CD4^(+)/CD8^(+) were calculated.The sequential organ failure assessment(SOFA)score of patients in the two groups was performed before treatment and on the 3^(rd),7^(th) day after treatment.The levels of red blood cell(RBC),white blood cell(WBC)and platelet(PLT)were detected before treatment and on the 1^(st),2^(nd),3^(rd),7^(th) day after treatment.The mechanical ventilation time in RICU,hospitalization time of RICU,the use of noradrenaline(NE)and the 28-day survival rate of patients in the two groups were recorded.Results There was no significant difference in the levels of serum PCT,CRP,IL-6,IL-10 and TNF-αbetween the two groups before treatment(P>0.05).The level

关 键 词：脓毒性休克 急性呼吸窘迫综合征 配对血浆滤过吸附 连续性静脉-静脉血液滤过 

分 类 号：R563.8[医药卫生—呼吸系统]