不同剂量血液过滤对重症监护室脓毒症患者疾病程度及内皮细胞相关指标的影响  

Effects of hemofiltration at varied doses on disease severity and indices related to endothelial dysfunction in ICU patients with sepsis

作　　者：刘媛 刘晶晶 高亚萍 熊磊 Liu Yuan;Liu Jingjing;Gao Yaping;Xiong Lei(Department of Critical Care Medicine,Hanzhong Central Hospital,Hanzhong Shaanxi 723000,China;Department of Hyperbaric Oxygen Therapy,Hanzhong Central Hospital,HanzhongShaanxi723000,China)

机构地区：[1]陕西省汉中市中心医院重症医学科,陕西汉中723000 [2]陕西省汉中市中心医院高压氧治疗室,陕西汉中723000

出　　处：《中国药物与临床》2023年第1期33-37,共5页Chinese Remedies & Clinics

摘　　要：目的分析不同剂量血液过滤对重症监护室(ICU)脓毒症患者疾病程度及内皮细胞相关指标的影响。方法回顾性分析2020年1月至2021年1月陕西省汉中市中心医院收治的行血液过滤的ICU脓毒症患者120例,分为对照组及观察组,对照组血液过滤剂量为35 ml·kg^(-1)·h^(-1),观察组血液过滤剂量为70 ml·kg^(-1)·h^(-1),比较2组患者血液过滤前后急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)、国际止血血栓学会(ISTH)有关弥散性血管内凝血(DIC)评分、ICU停留时间、机械通气时间、多脏器功能障碍综合征(MODS)发生情况、28 d死亡情况,血清肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、内皮细胞特异性分子-1(ESM-1)、可溶性细胞间黏附分子-1(sICAM-1)、血浆活化蛋白C(APC)、凝血酶调节蛋白(TM)、血管性假血友病因子(vWF)水平以及尿素氮、血清肌酐水平。结果与治疗前相比,2组患者APACHEⅡ评分、ISTH DIC评分明显降低,其中与对照组相比,观察组患者APACHEⅡ评分、ISTH DIC评分较低(P<0.05),观察组患者ICU停留时间、机械通气时间、MODS发生率、28 d死亡率较低(P<0.05)。与治疗前相比,2组患者ESM-1、TM、APC、vWF、sICAM-1水平低,与对照组相比,观察组患者ESM-1、TM、APC、vWF、sICAM-1水平低(P<0.05)。与治疗前相比,2组患者TNF-α、CRP、肌酐、尿素氮水平低,与对照组相比,观察组患者TNF-α、CRP、肌酐、尿素氮低(P<0.05)。结论70 ml·kg^(-1)·h^(-1)剂量血液过滤可有效缓解ICU脓毒症患者病症,减低炎症介质,保护内皮细胞功能,改善肾功能,减轻患者病情严重程度,改善脓毒症患者预后情况。Objective To investigate the effects of hemofiltration at varied doses on disease severity and indices related to endothelial dysfunction in patients with sepsis admitted to intensive care unit(ICU).Methods A retrospective study was performed on 120 patients with sepsis admitted to ICU for hemofiltration in Hanzhong Central Hospital of Shaanxi Province between January 2020 and January 2021.The patients were randomly divid-ed into the control group and study groups with a hemofiltration dose of 35 ml·kg^(-1)·h^(-1) and 70 ml·kg^(-1)·h^(-1),re-spectively.Before and/or after hemofiltration,the two groups were compared for acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores,disseminated intravascular coagulation(DIC)scores developed by In-ternational Society on Thrombosis and Hemostasis(ISTH),length of ICU stay,duration on mechanical ventilation,multiple organ dysfunction syndrome(MODS),28-day mortality,serum levels of tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),endothelial cell-specific molecule-1(ESM-1),soluble intercellular adhesion molecule-1(sICAM-1),plasma levels of activated protein C(APC),thrombomodulin(TM)and von Willebrand factor(vWF),and the levels of blood urea nitrogen(BUN)and serum creatinine(Scr).Results Compared with baseline,the APACHEⅡscore and ISTH-DIC score were significantly lowered in either group after hemofiltration.Compared with the control group,the study group had lower APACHEⅡscore and ISTH-DIC score(P<0.05),shorter ICU stay and duration on mechanical ventilation,lower incidence of MODS and 28-day mortality(P<0.05).Compared with baseline,the levels of ESM-1,TM,APC,vWF,and sICAM-1 after hemofiltration were lower in either group and,compared with the control group,the levels of ESM-1,TM,APC,vWF,and sICAM-1 were lower in the study group(P<0.05).Compared with baseline,the levels of TNF-α,CRP,Scr,and BUN after hemofiltration were lower in either group,and were even lower in the study group than with those in the control group(P<0.05).Conclusion Hemofiltratio

关 键 词：重症监护病房 脓毒症 内皮细胞 血液过滤 

分 类 号：R459.7[医药卫生—急诊医学]