血液灌流联合脉冲式高容量血液滤过治疗严重脓毒症的疗效

Analysis of effect of hemoperfusion combining with pulse high-volume hemofiltration in severe sepsis

目的:评价血液灌流(HP)联合脉冲式高容量血液滤过(PHVHF)治疗严重脓毒症的疗效及安全性。方法:2011年1月至2015年12月收住院的严重脓毒症患者,72 h内随机接受HP联合PHVHF或连续性血液滤过(CVVH)治疗,分别为36例及20例,观察两组治疗前后的心率、氧合指数、平均动脉压、去甲肾上腺素的用量、乳酸、肌酐、C反应蛋白、白细胞、炎症因子、APACHE II、SOFA评分以及观察28 d病死率。结果:两组患者经过72 h的血滤治疗后,心率、去甲肾、乳酸、肌酐、C-反应蛋白、白细胞、APACHE II、SOFA评分与治疗前比较均下降(P<0.05或P<0.01),MAP及氧合指数上升(P<0.01)。联合组明显优于CVVH组,尤其是去甲肾用量,氧合指数,CRP,WBC,APACHE II以及SOFA评分的改善(P<0.05或P<0.01)。联合组在血液灌流2 h后炎症因子即有明显的下降(P<0.01),治疗72 h后,两组炎症因子均有明显下降(P<0.01),且联合治疗组下降程度明显优于CVVH组(P<0.01)。联合组病死率33%,CVVH组病死率45%。结论:HP联合PHVHF治疗严重脓毒症效果显著,优于CVVH,可作为严重脓毒症的辅助治疗。

Objective To evaluate the clinical effect and safety of hemoperfusion combining with pulse high volume hemofiltration for treatment of severe sepsis. Methods A total of 56 cases were enrolled in this study and were divided into two groups： HP ＆ PHVHF group （n = 36） and CVVH group （n = 20）. The following parameters were measured in heart rate, PO2/FiO2, mean arterial pressure （MAP）, norepinephrine dose, lactic acid, serum creatinine, CRP, WBC, APACHE Ⅱ score, SOFA score, serum IL-6, IL-10 and TNF-α as well as the mortality before and after the treatment. Results After hemofihration in 72 h,the heart rate, norepinephrine dose, lactic acid, serum creatinine, CRP,WBC,APACHE Ⅱ] score,SOFA score decreased significantly than those before treatment in the two groups （P 〈 0.05 or P 〈 0.01 ）. MAP and PO2/FiO2 were improved （P 〈 0.01 ）. The combined therapy group was superior to CVVH group, especially in norepinephrine dose, PO2/FiO2,CRP,WBC,APACHE Ⅱ score,SOFA score （p 〈 0.05 or p 〈 0.01）. Inflammatory factors were decreased significantly after hemoperfusion in 2 h （P 〈 0.01 ）.After treatment in 72h, inflammatory factors of both two groups decreased than before（P 〈 0.01）. The combined therapy group was superior to CVVH group （P 〈 0.01 ）. The combined therapy group＇s mortality was 33%, while CVVH group＇s mortality was 45%. Conclusion HP combined with PHVHF has a significant effect in severe sepsis, fot which it is superior to CVVH, and can serve as an important adjuvant therapy.