采用CVVHDF联合血液灌流治疗重症脓毒症预后观察  

Prognosis of ICU Patients with Severe Sepsis Treated with CVVHDF Combined with Hemoperfusion

作　　者：任韩雯婧 乐涛[1] 田洪梅 蒲中春 余红[1] REN Hanwenjing;YUE Tao;TIAN Hongmei;PU Zhongchun;YU Hong(Chengdu Third People’s Hospital,Chengdu 610000,China)

机构地区：[1]成都市第三人民医院,四川成都610000

出　　处：《北华大学学报（自然科学版）》2023年第1期78-83,共6页Journal of Beihua University（Natural Science）

基　　金：四川省医学会重症医学(宜昌人福)专项课题(2016ZZ002(YCRF))。

摘　　要：目的探讨连续性静脉-静脉滤过透析(CVVHDF)联合血液灌流治疗重症脓毒症的临床效果.方法选取ICU收治的108例重症脓毒症患者,根据患者所接受的救治方案将其分为联合组(60例)和对照组(48例),联合组患者采用CVVHDF联合血液灌流治疗,对照组采用CVVHDF治疗,对比治疗前后不同时间两组患者的血清炎症因子、APACHEⅡ评分、器官功能障碍评分(SOFA)、凝血功能及预后差异.结果治疗前,测定两组患者的基线血清白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、血乳酸(Lac)水平,观察组和对照组具有很好的均衡性(P>0.05);治疗24、72 h后再次复查上述指标,结果显示,联合组患者IL-1、IL-6、TNF-α、Lac测定值均低于对照组,说明联合组的炎症反应程度控制得更好(P<0.05).治疗前,联合组和对照组的凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(Fib)、D二聚体(D-D)测定值比较差异无统计学意义(P>0.05);治疗24、72 h后,联合组患者PT测定值均低于对照组(P<0.05);治疗72 h后,联合组患者的APTT、D-D值低于对照组(P<0.05).治疗前,联合组和对照组的心率(HR)、平均动脉压(MAP)、氧和指数(OI)测定值比较差异均无统计学意义(P>0.05);治疗72 h后,联合组患者MAP、OI测定值均高于对照组患者(P<0.05).治疗前及治疗3 d后,联合组和对照组的APACHEⅡ评分、SOFA评分比较差异均无统计学意义(P>0.05);治疗7 d后,再次对上述指标进行评价,结果显示,联合组患者APACHEⅡ评分、SOFA评分均低于对照组,说明联合组患者病情得到更为显著的缓解(P<0.05).联合组和对照组患者的ICU死亡率比较差异均无统计学意义(P>0.05);治疗28 d后,联合组的死亡率低于对照组(P<0.05).结论CVVHDF联合血液灌流治疗ICU重症脓毒症患者,相对于单用CVVHDF治疗,能够尽早降低患者的炎症反应程度,改善凝血功能,并能降低患者器官衰竭程度,进而Objective To investigate the clinical effect of continuous veno-venous filtration dialysis(CVVHDF)combined with hemoperfusion in the treatment of patients with severe sepsis in the intensive care unit(ICU).Method 108 patients with severe sepsis were selected for retrospective analysis.According to the treatment methods,they were divided into a combination group of 60 cases and a control group of 48 cases.The patients in the combination group received CVVHDF combined with hemoperfusion.The control group was treated with CVVHDF,and the differences in serum inflammatory factors,APACHE II score,organ dysfunction score(SOFA),coagulation function and prognosis of patients were compared between the two groups at different times before and after treatment.Results Before treatment,there was no significant difference in the measured values of IL-1,IL-6,TNF-αand Lac between the combination group and the control group,there was no statistical significance(P>0.05);Before treatment,the measured values of PT,APTT,fib in the combination group and control group had no significant difference(P>0.05);After 24 h and 72 h treatment,the measured values of PT in the combination group were lower than those in the control group,and the difference was statistically significant(P<0.05).The D-D value in the combination group was lower than that of the control group,and the difference was statistically significant(P<0.05).Before treatment,the HR,MAP and OI of the combined group and the control group had no significant difference(P>0.05);After 72 hours of treatment,the measured values of MAP and OI in the combination group were higher than those in the control group,and the difference was statistically significant(P<0.05).After 7 days of treatment,the APACHEⅡscore and SOFA score of the combined group were lower than those of the control group,and the difference was statistically significant(P<0.05);the ICU death of the combined group and the control group compared with the control group,the difference was not statistically significant(P>0.

关 键 词：连续性静脉-静脉滤过透析 血液灌流 重症监护室 重症脓毒症 

分 类 号：R459[医药卫生—治疗学]