连续性血液净化对重症脓毒症患者内皮损伤的保护作用

Protective effect of continue blood purification on endothelial damage in patients with severe sepsis

目的研究连续性血液净化(CBP)治疗重症脓毒症患者,对血管内皮损伤的保护作用,及血管内皮损伤与病情演变之间的关系。方法17例重症脓毒症患者接受连续性血液净化(CBP)治疗共25次,观察患者接受CBP治疗前、治疗结束后次日血管性假性血友病因子(vWF)、凝血象、血常规及生化指标等变化;根据患者接受CBP治疗前和治疗后采集血标本时间不同,分为治疗前组和治疗后组;根据患者的预后分为存活组和死亡组。结果CBP治疗后组vWF较治疗前组显著降低(P<0.05),治疗后组APACHEⅡ和MODS评分也较治疗前组明显降低(P<0.05);CBP治疗前组,vWF与血白细胞计数(WBC)及血小板计数(PLT)呈正相关(P<0.01),与氧合指数呈负相关(P<0.05);CBP治疗后组,vWF与WBC和D-二聚体均呈正相关(P<0.01,0.05)。CBP治疗后存活组患者,vWF仅仅与血WBC呈正相关(P<0.01);而CBP治疗后死亡组患者,vWF与总脱水量及红细胞比积呈正相关(P<0.01),而与PT-INR和APTT呈负相关(P<0.01,P<0.05)。结论CBP治疗对重症脓毒症患者血管内皮损伤起到保护作用;在CBP治疗过程中,脱水过多,又可能加重血管内皮损伤。

Objective To study protective effect of continue blood purification （CBP） on endothelial damage in patients with severe sepsis, and to study relationship between endothelial damage and illness degree. Method Among 17 patients with severe sepsis, CBP was performed for 25 times, yon Willebraud factor （vWF）, blood coagulation parameters, blood routine and biochemical index were determined before treatment and in the next morning after CBP. According to the time of collecting blood, the blood samples were divided into the pre-treatment group and post-treatment group. According to the outcome, they were divided into the survival and death group. Results Compared pre-treatment group, the serum vWF, APACHE Ⅱ and MODS scores significantly decreased in post-treatment group （P 〈 0.05）. In pre-treatment group, vWF had a positive correlation with WBC and PLT （P 〈 0.01）, and a negative correlation with PO2/FiO2 （ P 〈 0.05）. In posttreatment group, vWF had a positive correlation with WBC and D-dimer （P 〈 0.01, P 〈 0.05）. However, vWF had a positive correlation with WBC only in the survival group （P 〈 0.01 ）, but vWF had a positive correlation with the amount of water removed by CBP and Hct （ P 〈 0.01 ） and had a negative correlation with PT- INR prothrombin time-international normalized ratio and APTT activated partial thromboplastin time （P 〈 0.01, 0.05 ） in the death group. Conclusions CBP has a protective effect on endothelial damage in patients with severe sepsis. But during the treatment of CBP, excessive dehydration may aggravate endothelial damage.