连续性血液净化治疗腹腔感染和肺部感染引起脓毒症患者临床效果观察

Observation of clinical effect of continuous blood purification treatment for patients with sepsis caused by abdominal infection and lung infection

目的探讨连续性血液净化治疗腹腔感染和肺部感染引起脓毒症患者临床效果。方法选自我院2014年1月-2015年12月期间收治的腹腔感染和肺部感染引起脓毒症患者60例,采用连续性血液净化治疗。比较治疗前后血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、超敏C-反应蛋白(hs-CRP)水平,治疗前后T淋巴细胞亚群比例变化,治疗前后、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体变化,治疗前后急性生理学评分和慢性健康状况评分Ⅱ(APACHEⅡ)评分变化。结果血清TNF-α、IL-6、hsCRP水平治疗后明显下降,且具有统计学差异(P<0.05);治疗后CD_3^+、CD_4^+明显增加,而CD_8^+明显下降,且具有统计学差异(P<0.05);PT治疗后无明显变化(P>0.05);APTT治疗后明显增加,D-二聚体治疗后明显下降,且具有统计学差异(P<0.05);APACHEⅡ评分治疗后明显下降,且具有统计学差异(P<0.05)。结论连续性血液净化治疗腹腔感染和肺部感染引起脓毒症患者,临床效果明显,可增强免疫功能,减轻炎症状态,改善凝血功能,值得临床推广。

Objective To investigate the clinical effect of continuous blood purification treatment for patients with sepsis caused by abdominal infection and lung infection. Methods 50 patients with sepsis caused by abdominal infection and lung infection from January 2014 to December 2015 were given continuous blood purification treatment. Their serum tumor necrosis factor-α （TNF-α）, interleukin -6 （IL-6）, high-sensitivity C-reactive protein （hs-CRP）, T lymphocyte subsets changes, prothrombin time （PT）, activated partial thromboplastin time （APTT）, D-dimer and acute physiology and chronic health evaluation score Ⅱ （APACHE Ⅱ） score changes were recorded and analyzed. Results The serum TNF-α, IL-6 and hs-CRP levels decreased significantly after treatment （ P 〈 0.05 ）. The levels of CD3＋ and CD4＋ increased significantly after treatment, whereas CD8 ＋ decreased significantly （ P 〈 0.05 ）. The level of PT had no significant difference （ P 〉 0. 05 ）. APTT increased, and D-dimer decreased significantly after treatment （ P 〈 0. 05 ）. APACHE Ⅱ score declined obviously after treatment （ P 〈 0. 05 ）. Conclusion The continuous blood purification treatment has significant clinical effect for patients with sepsis caused by abdominal infection and lung infection, which can enhance immune function, reduce inflammation, and improve blood clotting function, deserve to he generalized.