连续性血液净化治疗对重症肺炎合并心力衰竭患者心肌损伤指标、炎性因子及应激反应的影响  

Effects of Continuous Blood Purification Treatment on Myocardial Damage Indexes,Inflammatory Factors and Stress Response in Patients with Severe Pneumonia Complicated with Heart Failure

作　　者：左广霞 高香花 李晓燕[1] 冯悦 ZUO Guang-xia;GAO Xiang-hua;LI Xiao-yan(Department of Respiratory Medicine,Children’s Hospital of Zhengzhou University,Children’s Hos-pital of Henan Province,Zhengzhou Children’s Hospital,Zhengzhou,Henan,450000,China)

机构地区：[1]郑州大学附属儿童医院·河南省儿童医院·郑州儿童医院呼吸科,河南郑州450000

出　　处：《黑龙江医学》2023年第6期711-713,717,共4页Heilongjiang Medical Journal

基　　金：2020年河南省医学科技攻关计划联合共建项目(LHGJ20200653)。

摘　　要：目的:探讨连续性血液净化技术(Continuousbloodpurification,CBP)治疗对重症肺炎合并心力衰竭患者心肌损伤指标、炎性因子及应激反应的影响。方法:选取2018年1月—2021年2月郑州大学附属儿童医院收治的127例重症肺炎合并心力衰竭患者作为研究对象,根据治疗方案的差异分为对照组66例(常规治疗)和观察组61例(常规治疗+连续性血液净化治疗)。比较两组患者治疗后的临床症状改善时间、心肌损伤指标、炎性因子指标及急性生理学与慢性健康状况(Acute physioogy and chronic health evaluation;APACHE)Ⅱ评分变化。结果:观察组患者咳嗽改善时间、心率减慢时间、水肿消失时间均短于对照组患者,差异有统计学意义(t=11.847、10.487、12.852,P<0.05)。治疗后,两组患者B型脑钠肽(Brain Natriuretic Peptide,BNP)、心肌肌钙蛋白(Cardiac troponin,cTnT)及肌酸激酶同工酶(Creatine kinase isoen⁃zymes,CKMB)水平均下降,其中观察组患者下降最为明显,差异有统计学意义(t=13.643、11.638、10.202,P<0.05)。治疗后,对照组患者白介素1(Interleukin1,IL-1)、白介素10(Interleukin10,IL-10)、肿瘤坏死因子-α(Tumornecrosis factor-α,TNF-α)水平高于观察组患者,差异有统计学意义(t=77.535、2.540、6.076,P<0.05)。治疗后,APACHEⅡ评分均明显降低,差异有统计学意义(t=12.484、20.581,P<0.05),且观察组患者APACHEⅡ评分显著低于对照组患者,差异有统计学意义(t=10.891,P<0.05)。结论:对重症肺炎合并心力衰竭患者采用CBP治疗疗效显著,可抑制炎症反应,促进心肌功能恢复。Objective:To investigate the effects of continuous blood purification(CBP)therapy on myocardial injury indicators,inflammatory factors and stress response in patients with severe pneumonia combined with heart failure.Methods:127 patients with severe pneumonia combined with heart failure admitted to the hospital from January 2018 to February 2021 were selected as study subjects,and were divided into 66 cases in the control group(conventional treatment)and 61 cases in the observation group(conventional treatment+continuous hemodialysis)according to the treatment plan.The time to clinical symptom improvement,myocardial injury index,inflammatory factor index and changes in acute physioogy and chronic health evaluation(APACHE)II scores after treatment were compared between the two groups.Results:The time to improvement of cough,time to slowing of heart rate and time to disappearance of edema were shorter in the observation group than in the control group,and the differences were statistically significant(t=11.847,10.487,12.852,P<0.05).After treatment,the levels of B-type brain natriuretic peptide(BNP),cardiac troponin(cTnT)and creatine kinase isoenzymes(CKMB)decreased in both groups,with the most significant decrease in the observation group,and the difference was statistically significant(t=13.643,11.638,10.202,P<0.05).After treatment,the levels of interleukin 1(IL-1),interleukin 10(IL-10),and tumor necrosis factor-α(TNF-α)were higher in the control group than in the ob⁃servation group,and the differences were statistically significant(t=77.535,2.540,6.076,P<0.05).After treatment,APACHE II scores were significantly lower,with statistically significant differences(t=12.484,20.581,P<0.05),and APACHE II scores in the observation group were significantly lower than those in the control group,with statistically significant differences(t=10.891,P<0.05).Conclusion:CBP is effective in treating patients with severe pneumonia combined with heart failure,suppressing the inflam⁃matory response and promoting recovery of myo

关 键 词：连续性血液净化治疗 重症肺炎 心力衰竭 心肌损伤指标 炎性因子 应激反应 

分 类 号：R473.56[医药卫生—护理学]