连续性血液净化治疗29例重症脓毒血症的疗效观察

Observation of curative effects of continuous blood purification on the treatment of 29 patients with severe sepsis

目的探讨连续性血液净化(CBP)在重症脓毒血症患者治疗中的应用价值,为临床采用血液净化治疗脓毒症提供依据,从而为严重脓毒症患者提供有效的治疗方法。方法随机选取湖州市中心医院于2013年8月—2015年8月收治的58例重症脓毒血症患者作为研究对象,按数字表法(SPSS 16.0软件自动生成)将其随机分为观察组(n=29)与对照组(n=29),对照组予常规治疗,观察组在对照组基础上采用CBP治疗72 h。比较2组患者治疗前后症状、体征、血清生化指标及炎症指标水平及疾病严重程度评分情况。结果治疗后观察组患者发热、心慌、胸闷气促及烦躁症状得到有效缓解,心肾等脏器功能指标逐步好转稳定,内环境失衡得以纠正并趋于稳定,CRP、PCT、TNF-α、IL-8等炎症因子水平显著下降,同时体温、心率、WBC等全身炎症反应指标及血生化及代谢指标较对照组明显好转;循环氧合功能改善,乳酸水平亦较对照组明显下降,APACHE-Ⅱ、MODS及SOFA评分均降低,明显提高抢救存活率,观察组患者症状、体征、血清生化指标及炎症指标、疾病严重程度评分均明显优于对照组,差异有统计学意义(P<0.05)。结论 CBP能够有效清除患者体内过度释放的炎症因子及毒素,纠正内环境酸碱失衡,重建促、抗炎细胞因子的平衡,改善过度的炎症反应,并能够改善患者单核细胞功能,重建免疫稳态,有效阻断SIRS向MODS发展,促进器官功能恢复,降低患者病死率。

Objective To study the application value of continuous blood purification（ CBP） therapy in the treatment of patients with severe sepsis,to provide the basis for clinical use of blood purification in the treatment of sepsis,and provide effective treatment for patients with severe sepsis. Methods Fifty-eight cases of severe sepsis patients were randomly selected from August,2013 to August,2015 in our hospital were divided into observation group（ n = 29） and control group（n = 29）. Control group were given the conventional treatment,however,in addition to conventional treatment,the observation group were given the CBP therapy 72 h. Symptoms,signs,serum biochemical indicators,inflammation index level and disease severity scores were compared between the two groups. Results The conventional therapy plus treatment with CBP effectively alleviate the patients with fever,palpitation,chest tightness,shortness of breath and symptoms of irritable,organs such as heart renal function indexes improved steadily,internal environment imbalances be corrected and stable,the expression of PCT,TNF-α,IL-8,CRP and other inflammatory factors were significantly decreased. At the same time,the body temperature,heart rate,WBC and other systemic inflammatory response indicators and blood biochemical and metabolic indicators were significantly improved,and Improvement of cyclic oxygenation,Lactic acid levels were significantly decreased,APACHE-Ⅱ,MODS and SOFA score were decreased,significantly improve the survival rate. The Symptoms,signs,serum biochemical indicators,inflammation index level and disease severity scores of observation group were significantly better than the control group（ P〈0. 05）. Conclusion Excessive inflammatory factor and toxin could be effectively removed by CBP,which corrected internal environment acid-base balance,the balance of the cell factor,improve the inflammatory reaction,and can improve the function of patients with monocytes. Furthermore,CBP blocked the development of SIRS to MODS,and promoted the organ function recovery. At last,mortality could be reduced by the use of the CBP.