CVVH联合HA330血液灌流对创伤脓毒症急性肾损伤患者血清HMGB1、hs-CRP、PCT水平及28天死亡的影响  

Effects of CVVH combined with HA330 hemoperfusion on serum HMGB1,hs-CRP and procalcitonin levels and 28-day mortality in post-traumatic sepsis patients with acute kidney injury

作　　者：梁文生 吴伟[1] 王敏[2] LIANG Wensheng;WU Wei;WANG Min(Department of Emergency,Guangzhou Red Cross Hospital Affiliated to Jinan University,Guangzhou 510220,China;Department of Orthopedics,Guangzhou Red Cross Hospital Affiliated to Jinan University,Guangzhou 510220,China)

机构地区：[1]暨南大学附属广州红十字会医院急诊科,广州510220 [2]暨南大学附属广州红十字会医院骨科,广州510220

出　　处：《中国血液净化》2022年第5期326-330,共5页Chinese Journal of Blood Purification

摘　　要：目的探讨连续性静脉-静脉血液滤过(continuous veno-venous hemofiltration,CVVH)联合HA330血液灌流(hemoperfusion,HP)对创伤后脓毒症急性肾损伤患者血清高迁移率族蛋白1(high mobility group protein 1,HMGB1)、高敏C反应蛋白(high-sensitive C-reactive protein,hs-CRP)、降钙素原(procalcitonin,PCT)水平及28天死亡的影响。方法采用回顾性分析法,选取2020年2月~2021年3月暨南大学附属广州红十字会医院收治的86例创伤后脓毒症合并急性肾损伤(acute kidney injury,AKI)患者的临床资料,根据是否同意接受HA330血液灌流治疗分为HP组43例和CVVH组43例,CVVH组接受CVVH治疗,HP组在CVVH基础上联合HA330血液灌流器治疗,观察2组患者治疗前和治疗后3d、5d血清肌酐(Scr)、尿素氮(BUN)、HMGB1、hs-CRP、PCT水平及急性生理学及慢性健康状况评分系统(acute physiology and chronic health evaluation scoring system,APACHEⅡ)评分及序贯器官衰竭评分(sequential organ failure assessment,SOFA)变化,并记录24h尿量及28天死亡情况。结果治疗后3d、5d,HP组患者尿量较CVVH组多(3d:t=-8.158,P=<0.001;5d:t=-12.954,P=<0.001),血清Scr、BUN、PCT、hs-CRP、HMGB1水平及APACHEⅡ评分、SOFA评分均低于CVVH组[3d:t=9.698、P<0.001,t=3.313、P=0.001,t=7.739、P<0.001,t=7.266、P<0.001,t=2.549、P=0.006,t=7.340、P<0.001,3.556、P<0.001;5d:t=7.189、P<0.001,t=2.385、P=0.010,t=14.583、P<0.001,t=5.676、P<0.001,t=2.797、P=0.003,t=11.238、P<0.001,t=6.964、P<0.001]。与CVVH组相比,HP组住院时间[(12.37±5.11)d比(20.69±5.04)d,t=9.324,P<0.001]、机械通气时间更短[(9.36±2.47)d比(14.09±2.85)d,t=8.224,P<0.001],SOFA<8分患者28 d病亡率更低[5.00%比23.26%,χ^(2)=8.444,P=0.004]。结论CVVH联合HA330血液灌流治疗创伤后脓毒症急性肾损伤能提高治疗效果,减轻炎症反应,促进肾功能恢复,降低28天死亡率。Objective To investigate the effects of continuous veno-venous hemofiltration(CVVH)combined with HA330 hemoperfusion(HP)on serum high mobility group protein 1(HMGB1),high-sensitivity Creactive protein(hs-CRP),procalcitonin(PCT)and 28-day mortality in post-traumatic sepsis patients with acute kidney injury(AKI).Methods A total of 86 patients with post-traumatic sepsis and AKI treated during February 2020 to March 2021 in Guangzhou Red Cross Hospital Affiliated to Jinan University were retrospectively analyzed.They were divided into CVVH group(43 cases)and HP group(43 cases)according to whether the patient agreed to receive HA330 hemoperfusion treatment.CVVH group received CVVH treatment,and HP group was treated with the HA330 hemoperfusion device on the basis of CVVH.Blood creatinine(Scr),blood urea nitrogen(BUN),serum levels of HMGB1,hs-CRP and PCT,and scores of APACHEⅡand sequential organ failure assessment(SOFA)were recruited from both groups before treatment and after the treatment for 3 and 5 days.24-hour urine volume and 28-day mortality were recorded.Results After treatment for 3 days and 5 days,the urine volume increased more in HP group than in CVVH group(for 3 days:t=-8.158,P<0.001;for 5 days:t=-12.954,P<0.001).Serum levels of Scr,BUN,PCT,hs-CRP and HMGB1,and scores of APACHEⅡand SOFA were significantly lower in HP group than in CVVH group(for 3 days:t=9.698,3.313,7.739,7.266,2.549,7.340 and 3.556 respectively,P<0.001,=0.001,<0.001,<0.001,=0.006,<0.001 and<0.001 respectively;for 5 days:t=7.189,2.385,14.583,5.676,2.797,11.238 and 6.964 respectively,P<0.001,=0.010,<0.001,<0.001,=0.003,<0.001 and<0.001 respectively).The hospitalization days and mechanical ventilation days were lower in HP group than in CVVH group(for hospitalization days:12.37±5.11 vs.20.69±5.04 days,t=9.324,P<0.001;for mechanical ventilation days:9.36±2.47 vs.14.09±2.85 days,t=8.224,P<0.001).Patients with SOFA score<8 had a lower 28-day mortality rate(5.00%vs.23.26%,χ^(2)=8.444,P=0.004).Conclusion CVVH combined with HA for the tre

关 键 词：血液滤过 血液灌流 脓毒症 急性肾损伤 病亡率 

分 类 号：R459.5[医药卫生—治疗学]