胸腺肽α1联合连续血液净化对重症脓毒症患者肾功能、微循环及预后的影响  

Effect of thymosinα1 combined with continuous blood purification on renal function,microcirculation and prognosis of patients with severe sepsis

作　　者：吴炜 李叶宁[1] Wu Wei;Li Yening(Department of Critical Care Medicine,Luohe Central Hospital,Luohe City First People’s Hospital,Luohe 462600,China)

机构地区：[1]河南省漯河市中心医院漯河市第一人民医院重症医学科,漯河462600

出　　处：《中国实用医刊》2022年第8期50-54,共5页Chinese Journal of Practical Medicine

摘　　要：目的探讨胸腺肽α1联合连续血液净化(CBP)对重症脓毒症患者肾功能、微循环及预后的影响。方法抽取2019年6月至2021年6月漯河市中心医院重症监护病房(ICU)收治的91例重症脓毒症患者,按照随机数字表法分为对照组(44例,予CBP治疗)及治疗组(47例,予胸腺肽α1联合CBP治疗),均连续治疗1周。测定两组治疗前后肾功能指标[尿素氮(BUN)、血肌酐(Scr)、血尿酸(UA)、尿量]、舌下微循环指标[灌注血管壁比例(PPV)、小血管灌注比例(PPVs)、平均血流指数(MFI)、血流变异指数(FHI)、总血管密度(TVDs)、灌注血管密度(PVD)],记录两组治疗期间凝血功能障碍、低血容性休克、低血压、感染等并发症发生情况。采用治疗7 d后急性生理与慢性健康(APACHE-Ⅱ)评分、贯序器官功能衰竭(SOFA)评分及随访28 d病死率评估患者预后。结果与治疗前相比,两组治疗7 d后BUN、Scr、UA、FHI降低,而尿量、PPV、PPVs、MFI、TVDs、PVD升高(P<0.05);治疗7 d后,治疗组BUN、Scr、UA、FHI低于对照组,而尿量、PPV、PPVs、MFI、TVDs高于对照组(P<0.05)。治疗组并发症发生率(14.89%,7/47)与对照组(29.55%,13/44)比较差异未见统计学意义(P>0.05)。治疗7 d后,治疗组APACHE-Ⅱ评分、SOFA评分低于对照组(P<0.05);治疗组随访28 d病死率(8.51%,4/47)与对照组(15.90%,7/44)比较差异未见统计学意义(P>0.05)。结论与单一CBP治疗相比,胸腺肽α1联合CBP治疗重症脓毒症,可调节患者肾功能及微循环,改善预后,安全可靠。Objective To investigate the effects of thymosinα1 combined with continuous blood purification(CBP)on renal function,microcirculation and prognosis of patients with severe sepsis.Methods Ninety-one patients with severe sepsis admitted to the intensive care unit(ICU)of Luohe Central Hospital from June 2019 to June 2021 were selected.And they were divided into control group(44 cases,treated by CBP)and treatment group(47 cases,treated by CBP combined with thymosinα1)by random number table method.Both groups were given 1 week of treatment.Renal function indicators,including blood urea nitrogen(BUN),serum creatinine(Scr),blood uric acid(UA),urine volume,and sublingual microcirculation indicators,including proportion of perfused vessels(PPV),proportion of perfused small vessels(PPVs),mean flow index(MFI),flow variability index(FHI),total small vessel density(TVD),perfused vessel density(PVD),of the two groups were measured before and after treatment.The occurrence of coagulation dysfunction,hypovolemic shock,hypotension and infection of the two groups during treatment were recorded.The prognosis of patients was evaluated with the 7-day postoperative acute physiology and chronic health evaluation II(APACHEⅡ)score and sequential organ failure assessment(SOFA)score and 28-day mortality rate.Results Compared with preoperative indexes,BUN,Scr,UA and FHI were reduced,and urine volume,PPV,PPVs,MFI,TVDs and PVD were increased in the two groups after 7 days of treatment(P<0.05).Meanwhile,BUN,Scr,UA and FHI in the treatment group were significantly lower than those in the control group,and urine volume,PPV,PPVs,MFI and TVDs were significantly higher than those in the control group after 7 days of treatment(P<0.05).There was no significant difference in the incidence of complications between the treatment group(14.89%,7/47)and the control group(29.55%,13/44),P>0.05.The APACHE-Ⅱscore and SOFA score of the treatment group were significantly lower than those of the control group after 7 days of treatment(P<0.05).There was no s

关 键 词：脓毒症 胸腺肽Α1 连续血液净化 肾功能 微循环 预后 

分 类 号：R459.7[医药卫生—急诊医学]