血浆置换联合血液滤过在脓毒性休克患者中的疗效观察  

Evaluation of therapeutic plasma exchange combined with continuous renal replacement therapy in patients with early septic shock

作　　者：顾凌 施云弟 苏小翠 黄凤鸣 万鑫 黄日进 刘火根 Gu Ling;Shi Yundi;Su Xiaocui;Huang Fengming;Wan Xin;Huang Rijin;Liu Huogen(Department of Critical Care Medicine,Mindong Hospital,Fujian Medical University,Fu'an 355000,China)

机构地区：[1]福建医科大学附属闽东医院重症医学科,福安355000

出　　处：《中华急诊医学杂志》2022年第11期1463-1469,共7页Chinese Journal of Emergency Medicine

基　　金：福建省医学创新课题(2019-CXB-25);宁德市闽东医院院内课题(2020YN006)。

摘　　要：目的探讨血浆置换联合血液滤过能否改善早期脓毒性休克患者临床表现及预后。方法回顾性分析2017年12月至2020年12月福建医科大学附属闽东医院ICU收治的55例脓毒性休克患者。根据入科是否使用血浆置换联合血液滤过技术分为血液净化组(n=29)及常规治疗组(n=26)。两组患者均按2016年拯救脓毒症运动指南进行治疗。常规治疗组均不行血液滤过或(和)血浆置换治疗。血液净化组24 h内完成一次血浆置换后立即行血液滤过治疗。监测治疗前及治疗24 h后炎症指标、血流动力学指标、器官功能评分及记录28 d生存状况。计数资料采用χ2检验,计量资料采用t检验,采用Kaplan-Meier曲线评估28 d生存状况。结果(1)入组时两组性别、年龄、基础疾病、APACHEⅡ及SOFA评分差异无统计学意义。(2)入组时两组PCT、CRP及IL-6差异无统计学意义;治疗后,与常规治疗组相比,血液净化组PCT、CRP及IL-6均下降[PCT(ng/mL):(50.07±14.54)vs.(57.93±13.42),P=0.043;CRP(mg/L):(85.71±46.05)vs.(115.10±44.42),P=0.042;IL-6(pg/mL):(5957.45±2344.48)vs.(7522.94±3218.94),P=0.043],但WBC的下降差异无统计学意义。(3)入组时两组去甲肾上腺素剂量、平均动脉压、心率、外周循环阻力指数(systemic vascular resistance index,SVRI)、血管外肺水指数(extravascular lung water index,EVLWI)及乳酸差异无统计学意义。治疗后,血液净化组去甲肾上腺应用剂量、乳酸水平及EVLWI明显下降,SVRI明显上升{去甲肾上腺素泵入剂量[μg/(kg·min)]:(0.76±0.39)vs.(0.54±0.39),P=0.044;乳酸(μmmol/L):(7.74±4.22)vs.(4.51±1.62),P<0.001;EVLWI(mL/kg):(10.04±2.77)vs.(8.23±2.23),P=0.008;SVRI(dyn·s/cm2):(1103.14±364.94)vs.(1403.31±264.46),P=0.001};24 h两组静脉入量为(3852.07±686.43)mL vs.(4474.81±572.71)mL,P=0.001。(4)入组时两组APACHEⅡ评分及SOFA评分差异无统计学意义;治疗后,血液净化组APACHEⅡ评分及SOFA评分明显降低[APACHEⅡ评分:(14.07±Objective To investigate the efficacy of therapeutic plasma exchange with continuous renal replacement therapy in patients with early septic shock.Methods A total of 55 patients with septic shock admitted to ICU of Mindong Hospital Affiliated to Fujian Medical University from December 2017 to December 2020 were retrospectively analyzed.The patients were divided into the therapeutic plasma exchange group(n=29)and standard-therapy group(n=26)according to whether plasma exchange combined with hemofiltration was used.Patients in both groups were treated according to the 2016 Surviving Sepsis Campaign guidelines.No hemofiltration or/and plasma exchange therapy was performed in the standard-therapy group.In the therapeutic plasma exchange group,hemofiltration was performed immediately after plasma exchange within 24 h.The inflammatory indexes,hemodynamic indexes,organ function scores and 28-day mortality were monitored before and 24 h after treatment.χ2 test was used for counting data,t-test was used for measurement data,and Kaplan-Meier curve was used to evaluate 28-day survival status.Results(1)There were no differences in sex,age,underlying diseases,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and sequential organ failure assessment(SOFA)score before treatment between the two groups.(2)There were no significant differences in PCT,CRP and IL-6 between the two groups at enrollment.After treatment,PCT,CRP and IL-6 in the therapeutic plasma exchange group were significantly lower than those in the standard-therapy group[PCT(ng/mL):(50.07±14.54)vs.(57.93±13.42),P=0.043;CRP(mg/L):(85.71±46.05)vs.(115.10±44.42),P=0.042;IL-6(pg/mL):(5957.45±2344.48)vs.(7522.94±3218.94),P=0.043],but there was no significant difference in WBC between the two groups.(3)There were no significant differences in norepinephrine dose,mean arterial pressure,heart rate,systemic vascular resistance index(SVRI),extravascular lung water index(EVLWI)and Lactate level between the two groups.After treatment,the norepinephrine do

关 键 词：脓毒性休克 血浆置换术 血液滤过 预后 

分 类 号：R459.7[医药卫生—急诊医学]