配对血浆滤过吸附对脓毒性休克并ARDS患者血流动力学的影响  

Effects of coupled plasma filtration adsorption on hemodynamics in septic shock with ARDS patients

作　　者：高延秋 明月 晁琳琳 许瑞涛 李双凤 李晓燕 GAO Yanqiu;MING Yue;CHAO Linlin;XU Ruitao;LI Shuangfeng;LI Xiaoyan(Respiratory Intensive Care Unit,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007)

机构地区：[1]郑州大学附属郑州中心医院呼吸重症医学科,郑州450007

出　　处：《郑州大学学报（医学版）》2022年第4期537-542,共6页Journal of Zhengzhou University(Medical Sciences)

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

摘　　要：目的:探讨配对血浆滤过吸附(CPFA)对脓毒性休克并急性呼吸窘迫综合征(ARDS)患者血流动力学的影响。方法:回顾性分析郑州大学附属郑州中心医院收治的60例脓毒性休克并ARDS患者的临床资料,根据患者使用的血液净化模式,分为连续性静脉血液滤过(CVVH)组30例和CPFA组30例。测定两组治疗前后血清炎症因子、心率(HR)、平均动脉压(MAP)、乳酸(Lac)、氧合指数(OI)、SOFA评分等指标,比较两组14 d内停用血管活性药物率,Logistic回归分析患者14 d内停用血管活性药物的影响因素。结果:CPFA组和CVVH组患者治疗后第1、2、3天血清降钙素原(PCT)、C反应蛋白(CRP)、IL-6、IL-10、TNF-α水平均明显下降,CPFA组IL-6、IL-10、TNF-α水平降低程度大于CVVH组(P<0.05)。两组患者治疗后第1、2、3天MAP上升,HR、Lac下降(P<0.05)。两组患者治疗后第3、7天OI上升,SOFA评分下降(P<0.05)。CPFA组14 d内停用血管活性药物率高于CVVH组(P=0.014)。CPFA、3 d Lac清除率、3 dΔSOFA评分是14 d内停用血管活性药物的影响因素[OR(95%CI)分别为4.817(1.148~20.212)、1.095(1.024~1.171)、0.705(0.515~0.967),P<0.05]。结论:CPFA可以稳定脓毒性休克并ARDS患者的血流动力学,清除血清炎症介质,改善器官衰竭。Aim:To investigate the effects of coupled plasma filtration adsorption(CPFA)on hemodynamics in patients with septic shock and acute respiratory distress syndrome(ARDS).Methods:A retrospective study was performed on 60 cases of septic shock with ARDS received in the Zhengzhou Central Hospital Affiliated to Zhengzhou University.According to the blood purification mode,the patients were divided into continuous veno-venous hemofiltration(CVVH)group(30 cases)and CPFA group(30 cases).The indexes such as serum inflammation factors,heart rate(HR),mean arterial pressure(MAP),lactic acid(Lac),oxygenation index(OI),and SOFA score were compared between the two groups before and after treatment.The rate of discontinuation of vasoactive drugs of the two groups within 14 days was compared.The influencing factors of discontinuing vasoactive drugs within 14 days were analyzed by Logistic regression model.Results:The levels of procalcitonin(PCT),C-reactive protein(CRP),IL-6,IL-10,and TNF-αwere significantly lower in CPFA group and CVVH group on the 1st,2nd and 3rd day after treatment(P<0.05).The reduction of IL-6,IL-10 and TNF-αlevels in CPFA group were greater than those in CVVH group(P<0.05).MAP increased significantly,HR and Lac decreased significantly on the 1st,2nd and 3rd day after treatment in both groups(P<0.05).The OI increased significantly,and SOFA score decreased significantly in both groups on the 3rd and 7th day after treatment(P<0.05).The rate of vasoactive drugs withdrawal in CPFA group was significantly higher than that in CVVH group within 14 days(P=0.014).CPFA,3 days clearance of Lac,and 3 daysΔSOFA score were factors affecting vasoactive drugs withdrawal within 14 days[OR(95%CI)were 4.817(1.148-20.212),1.095(1.024-1.171),0.705(0.515-0.967),P<0.05].Conclusion:Treatment with CPFA could stabilize hemodynamics,clear serum inflammatory mediators and ameliorate organ failure in septic shock with ARDS patients.

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

分 类 号：R563.1[医药卫生—呼吸系统]