连续性血液滤过联合纳洛酮对MODS患者炎性因子水平及预后的影响

The effects of continuous veno-venous hemofiltration combined with naloxone on inflammatory factor and prognosis in patients with multiple organ dysfunction syndrome

目的探究连续性血液滤过联合纳洛酮对多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)患者炎性因子水平及预后的影响。方法选取2011年11月至2015年11月本院ICU收治的MODS患者84例为研究对象,依据随机数表法将入选患者分为观察组与对照组,每组各42例。对照组患者采用连续性血液滤过治疗,观察组患者在对照组治疗基础上联合纳洛酮治疗。比较两组患者治疗前及治疗后3、12、24、48小时血清白介素(IL)-6、IL-10、肿瘤坏死因子-α(TNF-α)水平,治疗后半个月及1个月预后及急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分变化情况。结果两组患者治疗后3、12、24、48小时血清IL-6、IL-10、TNF-α水平均较治疗前显著降低(P<0.05),观察组患者治疗后3、12、24、48小时血清IL-6、IL-10、TNF-α水平均低于同期对照组(P<0.05)。观察组患者治疗后半个月和1个月存活率均显著高于同期对照组(P<0.05)。两组患者治疗后半个月和1个月APACHEⅡ评分均较治疗前显著降低(P<0.05),观察组患者治疗后半个月和1个月APACHEⅡ评分均低于同期对照组(P<0.05)。结论连续性血液滤过联合纳洛酮可降低MODS患者炎性因子水平,减轻炎性反应,明显改善患者预后。

Objective To investigate the effects of continuous veno-venous hemofiltration（CVVH） combined with naloxone on inflammatory factor and prognosis in patients with multiple organ dysfunction syndrome（MODS）. Method 84 cases of patients with MODS from November 2011 to November 2015 in our hospital were randomly divided into observation group and control group, 42 cases in each group according to the random number table method. Control group patients were given CVVH, observation group paients were treated with naloxone on the basis of control group. Compared the changes of serum IL-6, IL-10, TNF-α levels between both groups before and after treatment of 3, 12, 24 and 48 hours. The conditions of prognosis in half a month and one month after treatment, and the changes of APACHE- Ⅱ scores in half a month and one month after treatment were compared. Result The serum IL-6, IL-10, TNF-α levels in both groups after treatment of 3, 12, 24 and 48 hours were signficantly decreased compared with before treatment（P〈0.05）; the serum IL-6, IL-10, TNF-α levels in observation group after treatment of 3, 12, 24 and 48 hours were signficantly lower than the same period in control group（P〈0.05）. The survival rate in observation group in half a month and one month after treatments were signficantly higher than the same period in control group（P〈0.05）. The APACHE Ⅱ scores in half a month and one month after treatment in both groups were significantly decreased compared with before treatment（P〈0.05）; the APACHE- Ⅱ scores in half a month and one month after treatments in observation group were signficantly lower than the same period in control group（P〈0.05）.Conclusion CVVH combined with naloxone can reduce the inflammatory factor in patients with MODS, relieve the inflammatory conditions, improve the prognosis obviously.