DPMAS联合CVVH治疗对脓毒症致多器官功能衰竭患者炎症反应和预后的影响  

Effect of DPMAS Combined with CVVH Treatment on Inflammatory Response and Prognosis in Patients with Multiple Organ Failure Caused by Sepsis

作　　者：殷瑶瑶[1] 黄河奔 郭琼琼 王俊霞[1] YIN Yaoyao;HUANG Heben;GUO Qiongqiong;WANG Junxia(Second Ward of Department of Nephrology,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China)

机构地区：[1]河南科技大学第一附属医院肾脏内科二病区,河南洛阳471000

出　　处：《河南医学研究》2023年第12期2176-2179,共4页Henan Medical Research

基　　金：2020年河南省医学科技攻关计划联合共建项目(LHGJ20200590)。

摘　　要：目的探讨双重血浆分子吸附系统(DPMAS)联合连续性静脉-静脉血液滤过(CVVH)治疗对脓毒症致多器官功能衰竭患者炎症反应及预后的影响。方法本研究为回顾性研究,收集2020年9月至2022年9月河南科技大学第一附属医院92例脓毒症致多器官功能衰竭患者的临床资料,依据患者的治疗方式,将其中42例接受CVVH治疗的患者纳入对照组,50例接受DPMAS联合CVVH治疗的患者纳入观察组。以治疗后30 d为观察终点,比较治疗前、治疗72 h时两组患者炎症因子水平[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)]、血常规[血红蛋白(Hb)、血小板计数(PLT)、白细胞计数(WBC)、中性粒细胞百分比(NEUT%)]以及序贯器官衰竭(SOFA)及急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。统计两组患者治疗后30 d内预后结局(病死、存活)。结果治疗72 h,两组血清IL-6、TNF-α、hs-CRP水平降低,与对照组比较,观察组上述血清水平更低(P<0.05);两组Hb、PLT、WBC、NEUT%水平均降低,与对照组比较,观察组Hb、PLT水平低,WBC、NEUT%水平高(P<0.05)。两组SOFA及APACHEⅡ评分均较降低,且与对照组比较,观察组SOFA及APACHEⅡ评分均低(P<0.05)。治疗后30 d内观察组病死率为8.00%(4/50),低于对照组病死率(23.81%,10/42),差异有统计学意义(χ2=4.422,P=0.036)。结论DPMAS联合CVVH模式可有效减轻脓毒症致多器官功能衰竭患者炎症反应,患者预后良好。Objective To explore the effect of double plasma molecular absorb system(DPMAS)combined with continuous veno-venous hemofiltration(CVVH)on inflammatory reaction and prognosis in patients with multiple organ failure caused by sepsis.Methods This study was a retrospective study that collected clinical data from 92 patients with multiple organ failure caused by sepsis in the First Affiliated Hospital of Henan University of Science and Technology from September 2020 to September 2022.Based on treatment methods,42 patients who received CVVH treatment were included in the control group,and 50 patients who received DPMAS combined with CVVH treatment were included in the observation group.The observation endpoint was 30 days after treatment.The levels of inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),hypersensitive C-reactive protein(hs-CRP)],blood routine[hemoglobin(Hb),platelet count(PLT),white blood cell count(WBC),neutrophil percentage(NEUT%)],sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores were compared between the two groups before treatment and 72 hours after treatment.The prognostic outcomes(death,survival)of the two groups within 30 days after treatment were counted.Results After 72 hours of treatment,the serum levels of IL-6,TNF-αand hs-CRP in the two groups were lower,and the above serum levels in the observation group were lower than those in the control group(P<0.05).The levels of Hb,PLT,WBC and NEUT%in the two groups decreased,but compared with the control group,the levels of Hb and PLT in the observation group were lower,and the levels of WBC and NEUT%were higher(P<0.05).The SOFA and APACHEⅡscores of the two groups were lower,and the SOFA and APACHEⅡscores of the observation group were lower than those of the control group(P<0.05).The mortality of the observation group was 8.00%(4/50)within 30 days after treatment,which was lower than that of the control group(23.81%,10/42),and the difference was statistically s

关 键 词：脓毒症 多器官功能衰竭 双重血浆分子吸附系统 连续性静脉-静脉血液滤过 炎症反应 预后 

分 类 号：R631[医药卫生—外科学]