分子吸附再循环系统治疗多脏器功能障碍综合征的临床研究

Clinical study on molecular adsorbent recirculating system in treating multiple organ dysfunctions syndrome

目的评价分子吸附再循环系统(MARS)治疗中毒所致多脏器功能障碍综合征(MODS)的效果。方法60例中毒所致MODS患者,随机均分为MARS治疗组、连续性肾脏替代治疗(CRRT)治疗组和常规综合治疗组。观察并比较组问血流动力学、肝肾功能、凝血功能、呼吸功能、炎症介质等方面指标,以及Marshall值在治疗前后的变化,观察比较三组患者60d内的生存曲线的差异。结果MARS治疗后平均心率减慢、平均动脉压升高;总胆红素、尿量明显增加;白细胞计数、D-二聚体水平降低,血小板计数明显升高;PaO_2、氧合指数水平均显著提高,气道峰压明显降低;促炎性介质(一氧化氮、IL-6、IL-8、TNF-α、LBP)与抗炎性介质(IL-10、IL-13)水平明显降低;的Marshall评分MARS组由9.45±1.68降低至7.45±1.73,CRRT组由9.45±1.72降低至8.52±1.46,常规综合治疗组由9.65±2.10降低至9.20±1.8,MARS治疗后优于常规综合治疗组和CRRT组(P<0 05)。呼吸频率、肌酐水平下降.SaO_2提高,优于常规综合治疗组(P<0.05)。60d生存概率分析,MARS组存活率为80%(16/20),优于常规综合治疗组35%(7/20)(P=0.003)与CRRT组50%(10/20)(P=0.040)。结论MARS治疗中毒导致MODS的疗效优于常规综合治疗和CRRT治疗。

Objective To appraise the effect of molecular adsorbent recirculating system （MARS） while treating multiple organ dysfunctions syndrome （MODS） caused by toxicosis. Methods Sixty patients who were diagnosised MODS that caused by severe pneumonia were enrolled. They were randomly divided into MARS cure group, Continuous Renal Replace Therapy （CRRT） cure group and integrated routine cure group. Compare the indexes among groups on flow dynamics, respiration function, liver and renal function, coagulation function, inflammatory mediators, and the Marshall values before and after therapy. Compare the survival curves among 3 groups in 60 days. Results After the patients with MODS were therapied, the Marshall values, the mean heart rates, the white cell counts, the peak inspiratory airway pressure, the serum total bilirubin, and the plasma D-dimer level decreased significantly; The mean artery pressure, the PaO2, the oxygenation index, the urine quantity, and the platelet counts increased significantly; The NO, TNF-α, IL-6, IL-8, LBP levels decreased significantly, and the IL-10 and IL-13 levels decreased concomitantly. These indexes of MARS group ameliorated better than routine integrated cure group and CRRT group （P〈 0.05）. Also after the patients with MODS were therapied the respiratory rate, the creatine level decreased significantly, and the SaO2, increased significantly, and These indexes of MARS group ameliorated better than integrated routine cure group（P〈0.05）. As to survival analyzing in 60 days, the survival rate was 80%（16/20） in the MARS group, and was 35%（7/20） in the integrated routine cure group, and was 50%（10/20） in the CRRT group. MARS group preceded to integrated routine cure group （P=0.003） and preceded to CRRT group （P=0.040） significantly. Conclusions MARS could cure MODS that caused by server toxicosis, and was better than integrated routine cure and CRRT .