连续性血液净化技术救治重症药物疹患者临床研究

Clinical study on continuous blood purification in the treatment of severe drug eruption

目的研究应用连续性血液净化在救治重症药物疹患者的临床疗效。方法 66例重症药物疹患者随机分2组:常规治疗组采用常规治疗,血液净化组在常规治疗基础上早期行连续性血液净化治疗。在治疗前及治疗后第8、15d,2组分别进行APACHEⅡ评分,检测血清肿瘤坏死因子a(TNF-a)、白细胞介素6(IL-6)及超敏C反应蛋白(hs-CRP)水平变化,行对比分析;在治疗后第8天观察全身皮疹状况改善程度并进行比较,并对患者并发症及28d转归情况进行比较。结果治疗第8d,全身皮疹状况改善程度,常规治疗组总效有效率为54.54%,血液净化组为87.87%,2组间差异有显著统计学意义(x2=31.290,P<0.01);APACHEⅡ评分在治疗后8、15d2组间差异显著,均有统计学意义(P<0.05);检测血浆TNF-a、IL-6、hs-CRP水平,血液净化组与常规治疗组在治疗第8d比较差异均有统计学意义(P<0.01);并发症及28天转归比较:常规组并发脓毒症发生率78.8%,净化组36.4%,(x2=12.160,P<0.01);常规组并发多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)为57.6%,血液净化组24.2%,2组间差异显著有统计学意义(x2=7.58,P<0.01);常规组病死率39.4%,净化组病死率12.2%,差异有统计学意义(x2=6.42,P<0.05)。结论连续性血液净化治疗重症药物疹,临床疗效可靠,显著改善患者预后,值得推广应用。

Objective To study the clinical application of continuous blood purification （hernopeffusion and hemofiltration） in patients with severe drug eruption. Methods Sixty-six patients with severe drug eruption were randomly divided into two groups, routine treatment group （n=33） and blood purification group （n=33）. Patients in the routine treatment group were treated with routine management, and those in the blood purification group were treated with early continuous blood purification in addition to routine management. Acute physiology and chronic health evaluation II （APACHE II） scores of the two groups were recorded, and blood samples for the measurement of plasma TNF-a, IL-6 and hs-CRP were collected at the first day before the treatment and at the 8th and 15th days after the treatment. These parameters were compared between the two groups. Skin rashes at the 8th day after the treatment and complications and prognosis at the 28th day after the treatment were compared between the two groups. Results After the treatment for 8 days, drug eruption improved remarkably. The overall effective rate was significantly higher in blood purification group than in routine treatment group （87.87% vs. 54.54%; X2=31.29, P〈0.01）. APAPHE 1/scores decreased gradually after the treatment for 8 and 15 days in both groups, but the differences in scores were statistically significant between the two groups （P〈0.05）. After the treatment for 8 days, plasma TNF-a, IL-6 and hs-CRP decreased more in blood purification group than in routine treatment group （P〈0.01）. When prognosis within 28 days was evaluated, the prevalence of sepsis was 36.4% and 78.8% （X2=12.160, P〈0.01）, the prevalence of multiple organ dysfunction syndrome （MODS） was 24.2% and 57. 6% （;（2= 7.580, P〈0.01）, and the mortality rate was 12.2% and 39.4% （;（2= 6.420, P 〈 0.05） in blood purification group and routine treatment group, respectively. Conclusion Continuous blood purification improves clinical symptoms and prognosis significantly in patients with severe drug eruption. Therefore, we recommend the use of continuous blood purification in this clinical situation.