MARS治疗重症恙虫病合并多脏器功能障碍综合征的疗效

Using the Molecular Adsorbent Recirculating System in the Treatment of Severe Tsutsugamushi Disease Complicated with Multiple Organ Dysfunction Syndrome

目的评价分子吸附再循环系统(MARS)治疗重症恙虫病合并多脏器功能障碍综合征(MODS)的效果。方法60例重症恙虫病合并MODS患者,随机分为MARS治疗组、连续性肾脏替代(CRRT)治疗组和常规综合治疗组。观察并比较组间血流动力学、肝肾功能、凝血功能、呼吸功能、炎症介质以及Marshall评分等在治疗前后的变化,比较3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,总胆红素明显降低,白细胞计数、D-二聚体水平明显降低,血小板计数明显升高,一氧化氮、TNF-α、IL-6、IL-8、IL-10、IL-13和LBP水平明显降低,PaO2和氧合指数水平均显著提高,气道峰压明显降低,Marshall值降低,均优于常规综合治疗组和CRRT组(P<0.05)。MARS治疗后呼吸频率和肌酐水平降低、SaO2和白蛋白水平升高,优于常规综合治疗组(P<0.05)。60d的生存概率分析,MARS组存活率90%(18/20),优于常规综合治疗组存活率45%(9/20)(P=0.001),优于CRRT组60%(12/20)(P=0.031)。结论MARS治疗重症恙虫病合并MODS疗效良好,优于常规综合治疗和CRRT治疗。

Objective To evaluate the value of using the molecular adsorbent recirculating system （MARS） in the treatment of severe Tsutsugamushi disease complicated with multiple organ dysfunction syndrome （MODS）. Methods Sixty patients diagnosed with severe Tsutsugamushi disease complicated with MODS were involved in this study. The patients were randomly divided into MARS cure group, continuous renal replace therapy （CRRT） cure group and the integrated routine cure group. Indexes on the flow dynamics, liver and renal function, coagulation function, respiration function, inflammatory mediators, and the Marshall values before and after therapy were compared between groups. The 60-day survival curves between the 3 groups were also compared. Results After MARS therapy, the Marshall values, mean heart rates, peak inspiratory airway pressure, serum total bilirubin, white cell counts and the plasma D-dimer levels were significantly decreased. The mean artery pressure, PaO2, oxygenation index, urine quantity and the platelet counts were significantly increased. The levels of NO, TNF-α, IL-6, IL-8 and LBP were significantly decreased. The levels of IL-10 and IL-13 were decreased concomitantly. These indexes in the MARS group were better than the routine integrated cure group and CRRT group （P〈0.05）. After MARS therapy, the respiratory rate and the creatine level were significantly decreased, the levels of SaO2 and albumin were increased significantly, and these indexes in the MARS group were better than integrated routine cure group （P〈0.05）. In the survival study, the survival rate was 90% （18/20） in the MARS group, 45% （9/20） in the integrated routine cure group, and 60% （12/20） in the CRRT group. Conclusion MARS can be used in the treatment of severe Tsutsugamushi disease complicated with MODS.