烧伤早期应用IHF联合HP防治脓毒症的临床效果

Early application IHF combined with HP to prevent sepsis in burns

目的研究严重烧伤早期应用间歇性血液滤过(IHF)联合血液灌注流(HP)防治脓毒症的临床效果。方法选取2013年3月至2015年12月于惠州市中心人民医院入院治疗的烧伤患者50例,随机分为研究组(n=25)及对照组(n=25)。对照组按常规方法进行治疗,研究组在此基础进行IHF+HP治疗(伤后4、6、8、11 d)。记录两组患者伤后4、6、8、11、15 d的体温(BT)、心率(HR)和呼吸频率(BPM);白细胞数量(WBC)、中性粒细胞(NEUT)、尿素氮(BUN);白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)及高迁移率簇蛋白-1(HMGB-1);LPS和PCT。结果研究组伤后4、6、8、11、15 d的HR、WBC、BUN、IL-1、TNF-α、HMGBI、LPS和LCT均低于对照组,差异有统计学意义(P<0.05);研究组除伤后4 d外,其余天数BPM均明显低于对照组,差异有统计学意义(P<0.05);研究组除伤后6 d外,其余天数BT明显低于对照组,差异有统计学意义(P<0.05);研究组除伤后8 d外,其余天数IL-6均低于对照组,差异有统计学意义(P<0.05)。结论 IHF+HP的治疗方案对严重烧伤患者是可行有效的,能够防治脓毒症的发生。

Objective To study the application of inter-mittent hemofiltration（IHF） combined with blood flow hemoperfusion（HP） to prevent sepsis（Sepsis） for the severe burns. Methods March 2013-December 2015, 50 hospitalized burn patients were selected and randomly divided into study group and common group, 25 cases each. Common group was treated according to the conventional method, while study group was treated on this basis IHF＋HP treatment. Indicators were recorded in both groups of patients. By Fisher method, measurement variance and LSD-t test each index data were analyzed. Results 4,6,8,11,and 15 days after injury,the levels of heart rate（HR）, white blood cell（WBC）, blood urea nitrogen（BUN）,IL-1,tumor necrosis factor-α（TNF-α）,high mobility group box 1（HMGB-1）,lipopolysaccharides（LPS） and proealeitonin（PCT） of the study group were significantly lower than those of the control group（P〈0.05）. The BPM levels of the study group at all time points except day 4 after injury were significantly lower than those of the control group（P〈0.05）; the BT levels of the study group at all time points except day 6 after injury were significantly lower than those of the control group（P 0.05）; the level of IL-6 of the study group at all time point except day 8 after injury were significantly lower than those of the control group（P〈0.05）. Conclusion Early IHF＋HP treatment for severely burned patients is feasible and effective topreventsepsis.