连续性血液净化治疗脓毒症患者的临床研究

Clinical research of continuous blood purification therapy in patients with sepsis

目的探讨连续性血液净化（CBP）治疗脓毒症患者的临床效果及影响预后的相关因素。方法回顾性分析2009年1月～2010年12月长沙市第四医院ICU收治的行CBP治疗的脓毒症患者17例（CBP组），选择同期未行CBP治疗的脓毒症患者17例（非CBP组）为对照，比较两组患者的一般资料、治疗前后血液生化改变、急性生理学及慢性健康状况评分Ⅱ（APACHEII）等。对比分析两组治疗前后临床参数的变化及与预后的关系。结果①治疗后两组心率、呼吸频率、中心静脉压（CVP）、血肌酐（SCr）、氧合指数（PO2/FIO2）等与治疗前比较，差异均有统计学意义（P〈0．05）。治疗后CBP组平均动脉压（MAP）[（88．3±12．5）mmHg]、CVP[（12．7±5．0）cmH20]、SCr[（225．0±113．2）μmol／L]、C反应蛋白（CRP）[（103．3±82．3）mg／mL]、PO2/FIO2[（2．51±0．72）]、APACHEⅡ评分[（22．8±6．3）分]与非CBP组比较[（81．9±15．1）mmHg、（14．1±3．9）cmH2O、（172．3±141．8）μmol／L、（150．9±109．1）mg／mL、（1．91±0．46）、（28．4±2．1）分]，差异均有统计学意义（P〈0．05）。②CBP组与非CBP组比较．转出ICU比例较高，病死率较低，差异均有统计学意义（P〈0．05）。③多因素回顾性分析显示，APACHEⅡ评分、PO2/FIO2以及MAP是与预后相关的独立危险因素。结论CBP治疗脓毒症的效果优于非血液净化方式。治疗前患者的疾病严重程度是决定预后的重要因素。

Objective To investigate clinical efficacy of the continuous blood purification （CBP） in the treatment of sepsis in the intensive care unit （ICU） and prognostic factors. Methods 17 cases with sepsis treated with CBP from January 2009 to December 2010 in Department of ICU, the Fourth Hospital of Changsha City were selected as CBP group, 17 patients with sepsis without CBP in the same term were chosen as non- CBP group. The general information of two groups, blood biochemical changes before and after treatment, acute physiology and chronic health evaluation II （APACHE II score） were compared, and changes in clinical parameters and prognosis before and after treatment were comparative analyzed. Results ① The differences of heart rate, respiratory rate, CVP, SCr, PO2/FIO2 in the two groups before and after treatment were statistically significant （P 〈 0.05）. The differences of MAP, CVP, SCr, CRP, PO2/FIO2, APACHE II score after treatment between the CBP group [（88.3±12.5） mm Hg, （12.7±5.0） cm H2O, （225.0±113.2）μmol/L, （103.3±82.3） mg/mL, （2.51±0.72）, （22.8±6.3） points] and non-CBP group [（81.9±15.1） mm Hg, （14.1±3.9） cm H2o, （172.3±141.8） μmol/L, （150.9±109.1） mg/mL, （1.91±0.46）, （28.4±2.1） points] were statistically significant （P 〈 0.05）. ②The percentage of turning out of ICU in CBP group was higher than that in non-CBP group, fatality rate in CBP group was lower than that in non-CBP group, the differences were statistically significant （P 〈 0.05）. ③APACHE I1 score, PO2/FIO2, MAP were the independent risk factors related to prognosis according to the multiple-factor analysis. Conclusion CBP treatment of sepsis is more effective than non-blood purification, treatment of patients with disease severity is an important prognostic factor in the decision.