血液灌流对脓毒性休克高迁移率族蛋白B-1清除效果的研究

Effect of hemoperfusion on clearance of high-mobility group protein B-1 in patients with septic shock

目的分析HA330血液灌流对脓毒性休克患者高迁移率族蛋白B-1清除效果及对患者组织灌注的影响。方法采用前瞻性单中心研究方法,选取2015年1月-2016年12月重症医学科脓毒症休克患者共60例,采用数字随机法分成两组,常规组30例和灌流组30例。常规组按常规治疗,灌流组在常规治疗基础上采用HA330血液灌流,每次灌流时间持续2h,连续3d。记录患者治疗前及治疗第4天的血流动力学指标:包括平均动脉压(MAP)、心率(HR)、心脏指数(CI)、左心室收缩力指数(dpmax)和外周血管指数(SVRI),血管活性药物的使用率。同时检测高迁移率族蛋白B-1(HMGB-1)、乳酸(Lac),前降钙素(PCT)、C-反应蛋白(CRP)水平,记录患者ICU住院时间及机械通气时间。结果两组患者治疗后血流动力学指标均好转,MAP、CI、dpmax升高,HR、SVRI、乳酸下降,且灌流组指标变化幅度优于常规治疗组(P<0.05);两组患者治疗后炎症指标CRP,PCT及HMGB-1水平均下降,且灌流组指标变化幅度优于常规治疗组(P<0.05),血管活性药物使用率灌流组由93.3%下降至23.3%,常规组由96.7%下降至33.3%,两组比较差异有统计学意义(P<0.05);两组患者治疗后APAHCEⅡ评分均下降,灌流组治疗后APAHCEⅡ评分下降值(6.60±2.27)高于对照组(4.85±1.80),差异有统计学意义(P<0.05);两组机械通气时间和ICU住院时间比较差异无统计学意义。结论血液灌流能更好地减少脓毒性休克患者的HMGB-1水平,降低炎症反应,稳定血流动力学,改善组织灌注。

OBJECTIVE To observe the effect of HA330 hemoperfusion on clearance of high-mobility group protein B-1(HMGB-1)in patients with septic shock and the impact on tissue perfusion.METHODS By means of prospective,single-center study,a total of 60 patients with septic shock who were treated in critical care medicine department from Jan 2015 to Dec 2016 were enrolled in the study and randomly divided into the conventional group with30 cases and the perfusion group with 30 cases.The conventional group with treated with rontine therapy,while the perfusion group was given additional HA330 hemoperfusion on basis of the conventional therapy,2 hours for each time of perfusion,3 consecutive days,The hemodynamics indexes of the patients,including mean arterial pressure(MAP),heart rate(HR),cardiac index(CI),left ventricular contractility index(dpmax),systemic vascular resistance index(SVRI)and utilization rate of vasoactive drugs,were recorded before the treatment and on the fourth day of treatment.The levels of HMGB-1,lactic acid(Lac),procalcitonin(PCT)and C-reactive protein(CRP)were detected,and the length of ICU stay and mechanical ventilation duration of the patients were recorded.RESULTS The hemodynamics indexes of the two groups of patients were improved after the treatment,the MAP,CI and dpmax were elevated,the HR,SVRI and Lac were reduced,and the above indexes changed more significantly in the perfusion group than in the conventional group(P<0.05).The levels of inflammatory indexes CRP,PCT and HMGB-1 of the two groups of patients were reduced after the treatment,and the above indexes changed more significantly in the perfusion group than in the conventional group(P<0.05).The utilization rate of vasoactive drugs was decreased from 93.3%to 23.3%in the perfusion group,from 96.7%to 33.3%in the conventional group,and there was significant difference between the two groups(P<0.05).The APAHCEⅡscore of the two groups of patients was reduced after the treatment;the decrease of APAHCEⅡscore of the perfusion group was(6.60±2.27),significantly higher than(4.85±1.80)of the control group(P<0.05).There were no significant differences in the mechanical ventilation duration and length of ICU stay between the two groups of patients.CONCLUSION The hemoperfusion may effectively reduce the level of HMGB-1 of the septic shock patients and inflammatory reactions,stabilize the hemodynamics and improve the tissue perfusion.