机构地区:[1]绍兴市人民医院内科重症监护室,绍兴312000 [2]绍兴市人民医院外科重症监护室,绍兴312000
出 处:《中华创伤杂志》2024年第11期1008-1015,共8页Chinese Journal of Trauma
基 金:浙江省医药卫生科技计划(2023KY1261)。
摘 要:目的探讨连续性血液净化(CBP)治疗对创伤脓毒症患者外周血单个核细胞线粒体功能及临床预后的影响。方法采用前瞻性队列研究分析2023年1月至2024年6月绍兴市人民医院重症监护室收治的90例创伤脓毒症患者的临床资料。均在标准操作规程(SOP)治疗基础上根据患者或家属是否接受CBP治疗,分为CBP组及非CBP组。比较两组入ICU时及治疗12、24、48 h时单个核细胞线粒体DNA(mtDNA)拷贝数和线粒体呼吸链复合体Ⅴ活性、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-10水平;比较两组入ICU时、治疗48 h时急性生理学与慢性健康状况评估Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA);比较两组住ICU时长、总住院时长、入ICU后28 d病死率。结果共纳入创伤脓毒症患者90例,其中男56例,女34例;年龄18~82岁[51.3(38.7,70.6)岁]。损伤严重度评分(ISS)16~54分[36.2(17.0,53.6)分]。CBP组52例,非CBP组38例。患者均获随访7~14 d[10.0(8.0,12.0)d]。入ICU时,CBP组mtDNA拷贝数为638.5±124.0,非CBP组为634.7±122.1(P>0.05);治疗12、24、48 h时,CBP组mtDNA拷贝数分别为564.2±105.6、415.7±83.5、303.7±77.0,均明显低于非CBP组的622.9±120.2、581.5±113.6、530.7±97.8(P<0.05或0.01)。治疗12、24、48 h时,两组mtDNA拷贝数均较入ICU时持续下降(P<0.05)。入ICU时,CBP组线粒体呼吸链复合体Ⅴ活性为(74.0±26.0)pg/ml,非CBP组为(72.8±25.3)pg/ml(P>0.05);治疗12、24、48 h时,CBP组线粒体呼吸链复合体Ⅴ活性分别为(69.4±24.2)pg/ml、(78.3±26.8)pg/ml、(91.5±33.5)pg/ml,均明显高于非CBP组的(65.3±23.6)pg/ml、(60.7±19.4)pg/ml、(53.8±16.9)pg/ml(P<0.05或0.01)。治疗12 h时,两组粒体呼吸链复合体Ⅴ活性均较入ICU时有所下降(P<0.05);治疗24、48 h时,CBP组复合体Ⅴ活性较均入ICU时及治疗12 h时持续上升(P<0.05),而非CBP组均持续下降(P<0.05)。入ICU时,CBP组TNF-α、IL-6、IL-10水平分别为(51.6±17.1)pg/ml、(174.1±57.3)pg/ml、(67.6±16Objective To investigate the effects of continuous blood purification(CBP)on mitochondrial function of peripheral blood mononuclear cells and clinical prognosis of patients with traumatic sepsis.Methods A prospective cohort study was used to analyze the clinical data of 90 patients with traumatic sepsis admitted to the Intensive Care Unit of Shaoxing People′s Hospital from January 2023 to June 2024.Based on standard operating procedures(SOP),patients were divided into CBP group and non‑CBP group according to whether they received CBP treatment.The mitochondrial DNA(mtDNA)copy number,activity of mitochondrial respiratory chain complex V,levels of tumor necrosis factor‑α(TNF‑α),interleukin(IL)‑6 and IL‑10 in the mononuclear cells on ICU admission and at 12,24 and 48 hours after treatment were compared between the two groups.Acute physiology and chronic health evaluation II(APACHE II)score and sequential organ failure assessment(SOFA)score on ICU admission and at 48 hours after treatment were detected in the two groups.The length of ICU stay,total length of hospital stay and 28‑day mortality after ICU admission were compared between the two groups.Results A total of 90 patients with traumatic sepsis were included,comprising 56 males and 34 females,aged 18‑82 years[51.3(38.7,70.6)years],with injury severity score(ISS)of 16‑54 points[36.2(17.0,53.6)points].There were 52 patients in the CBP group and 38 in the non‑CBP group.All the patients were followed up for 7‑14 days[10.0(8.0,12.0)days].On ICU admission,the mtDNA copy number was 638.5±124.0 in the CBP group and 634.7±122.1 in the non‑CBP group(P>0.05).At 12,24 and 48 hours after treatment,the mtDNA copy number in the CBP group was 564.2±105.6,415.7±83.5 and 303.7±77.0 respectively,significantly lower than 622.9±120.2,581.5±113.6,530.7±97.8 in the non‑CBP group(P<0.05 or 0.01).At 12,24 and 48 hours after treatment,the mtDNA copy number in both groups continued to decrease compared with that on ICU admission(P<0.05).On ICU admissio
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