连续性血液净化治疗重症脓毒症疗效分析

Efficacy evaluation of continuous blood purification on prognosis of patients with severe sepsis

目的探讨连续血液净化(continuous blood purification,CBP)对重症脓毒症患者的疗效。方法回顾性分析解放军总医院重症医学科2010年1月-2014年1月60例重症脓毒症患者临床资料,分为常规治疗组30例和血液净化组30例,分析两组28 d生存率,以及在治疗前、治疗后72 h相关血流动力学及炎症感染指标变化。结果 CBP治疗后患者平均动脉压、心率和氧合指数(Pa O2/Fi O2)均较治疗前有所改善(P<0.05);与常规治疗组相比,CBP治疗组在C-反应蛋白、降钙素原、白介素-6、脑利钠肽及血乳酸等指标均降低(P<0.05),氧合指数上升(P<0.05),急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)亦降低(P<0.05);但两组在28 d生存率上差异无统计学意义(P=0.286)。结论对重症脓毒症患者采用连续性血液净化治疗,早期能有效清除炎症因子,维持血流动力学稳定,改善氧合功能,但对患者生存率影响还需进一步研究。

Objective To investigate the curative effect of continuous blood purification （CBP） on prognosis of patients with severe sepsis.Methods Clinical data about 60 patients with severe sepsis in ICU from January 2010 to January 2014 were retrospectively analyzed.These patients were divided into two groups：CBP group （n=30） and the control group （n=30）.Patients in the control group received conventional therapy while in CBP group continuous blood purification was added.28-day survival rate as well as the changes of haemodynamics and inflammatory factors before and 72 h after therapy were analyzed between these two groups.Results There were remarkable amendment in mean arterial blood pressure,heart rate and oxygenation index （PaO2/FiO2） in patients of CBP group （P ＜ 0.05）.Compared with those in the control group,the c-reactive protein,procalcitonin,interleukin-6,brain natriuretic peptide and serum lactic acid significantly decreased in CBP group （P ＜ 0.05）,while the oxygenated index increased greatly （P ＜ 0.05）.Although the acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） decreased significantly in CBP group compared with those in the control group （P ＜ 0.05）,there was no obvious difference in 28-day survival rate between these two groups （P=0.286）.Conclusion The therapy of CBP can remove inflammatory factors,keep haemodynamics stable and improve oxygenated function effectively in patients with severe sepsis.However,its effects on survival rate still need to be proved in the further study.