血液灌流治疗孙氏手术后早期细胞因子风暴的临床研究  

Clinical study on hemoperfusion for early cytokine storm following Sun’s procedure

作　　者：李香敏 吕珊珊 贺清 冯波 闫晓丽 郑云 张春蕾 马继鹏 赵荣 金振晓 张平 Li Xiangmin;Lv Shanshan;He Qing;Feng Bo;Yan Xiaoli;Zheng Yun;Zhang Chunlei;Ma Jipeng;Zhao Rong;Jin Zhenxiao;Zhang Ping(Department of Nephrology of The Second Affiliated Hospital,Department of Cardiovascular Surgery of The First Affiliated Hospital,Air Force Medical University,Shaanxi Xi’an 710032,China)

机构地区：[1]空军军医大学第二附属医院肾脏内科,西安710038 [2]空军军医大学第一附属医院心血管外科,西安710032

出　　处：《中国体外循环杂志》2025年第1期36-39,57,共5页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金(82370273);陕西省创新能力支撑计划(2023-CX-PT-06);陕西省一般项目(2021XC032);新冠感染临床新技术研究(XJZT23XG28);西京医院交叉项目(XJZT24JC37)。

摘　　要：目的研究血液灌流(HP)治疗孙氏手术后早期细胞因子风暴(CS)的临床效果。方法回顾性收集空军军医大学第一附属医院心血管外科2021年7月至2023年7月期间收治急性A型主动脉夹层行孙氏手术后24 h内发生CS的患者资料,共54例。按照患者是否应用HP治疗分为血液灌流组(27例)和对照组(27例),比较两组患者的预后情况差异。结果两组患者的基线资料无统计学差异。HP治疗可明显降低患者白介素-6(1 d、2 d、3 d、4 d、7 d均P<0.001)及C-反应蛋白水平(1 d P=0.034、2 d P=0.002、3 d P=0.001、4 d P=0.003、7 d P=0.003);血液灌流组在机械通气时间(P<0.001)、ICU住院时间(P=0.013)及术后住院时间(P=0.021)均较对照组短;但术后谵妄(P=0.526)、二次插管(P>0.999)、连续性肾替代治疗(CRRT)(P>0.999)、肺部感染(P=0.728)、死亡(P>0.999)等发生率差异无统计学意义。结论HP治疗可降低孙氏手术后早期CS患者白细胞介素-6及C-反应蛋白水平,缩短机械通气时间、ICU住院时间及术后住院时间,但未能改善术后谵妄、肺部感染、死亡发生及减少二次插管和CRRT应用。Objective To investigate the clinical efficacy of hemoperfusion(HP)in the treatment of early postoperative cytokine storm(CS)after Sun’s procedure.Methods The data of 54 patients with acute type A aortic dissection(AAD)who developed CS within 24 h post Sun’s procedure were retrospectively collected from July 2021 to July 2023 in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Air Force Medical University.The patients were divided into hemoperfusion group(27 cases)and control group(27 cases)according to whether they were treated with HP,and the prognosis of the two groups were compared.Results There were no significant differences in baseline characteristics between the two groups.HP significantly reduced IL-6 levels(days 1,2,3,4,7;all P<0.001)and CRP levels(day1,P=0.034;day 2,P=0.002;day 3,P=0.001;day 4,P=0.003;day 7,P=0.003).Compared to the control group,the mechanical ventilation time(P<0.001),ICU stay(P=0.013)and postoperative hospital stay(P=0.0212)were shorter in the hemoperfusion group.However,there were no statistically significant differences in postoperative delirium(P=0.526),reintubation(P>0.999),CRRT(P>0.999),pulmonary infection(P=0.728),and mortality(P>0.999)between the groups.Conclusion HP effectively reduces the levels IL-6 and CRP levels,shortens mechanical ventilation time,ICU stay and postoperative hospital stay in patients with early CS following Sun’s procedure.However,it does not improve the incidence of postoperative delirium,pulmonary infection,death,or mortality,nor does it reduce the need for reintubation or CRRT.

关 键 词：血液灌流 体外循环 孙氏手术 中低温停循环 A型主动脉夹层 细胞因子风暴 围术期 

分 类 号：R654.3[医药卫生—外科学]