血液滤过对严重脓毒血症炎症因子与血流动力学影响

Effect of hemofiltration on severe sepsis inflammatory cytokines and hemodynamics

目的探讨血液滤过对严重脓毒血症炎症因子与血流动力学的影响。方法选取重庆市三峡中心医院自2013年3月至2014年11月收治的68例严重脓毒症患者为研究对象,观察高容量血液滤过透析前后,脓毒症患者的急性生理与慢性健康评分(APACHEⅡ),临床肺部感染评分(CPIS),血流动力学及肿瘤坏死因子-α(TNF-α)、白细胞介素-6、白细胞介素-8等炎症因子的水平变化。结果严重脓毒症患者进行血液透析后CPIS评分,APACHEⅡ评分均明显低于透析前,差异均有统计学意义(P<0.05)。治疗前、后肿瘤坏死因子-α(TNF-α)、谷丙转氨酶(GPT)、血清白蛋白、白细胞介素-6、白细胞介素-8、白细胞、血小板、血糖、血肌酐、平均动脉压(MAP)、氧合指数(PaO_2/FiO_2)、中心静脉压(CVP)等指标比较,差异均有统计学意义(P<0.05)。结论血液滤过对严重脓毒血症患者器官衰竭及全身炎症反应疗效显著,明显降低患者血清炎症因子,促进血清电解质平衡,抑制全身炎症反应的进展,改善患者全身血流动力学及预后情况。

Objective To investigate the application of hemofiltration on severe sepsis inflammatory factors and hemodynamic value.Methods A retrospective study was performed on 68 cases of patients with severe sepsis who were admitted from March 2013 to November 2014. Before and after high volume hemofiltration dialysis,the acute physiology and chronic health evaluation（ APACHE Ⅱ）score,clinical pulmonary infection（ CPIS） score,level changes of hemodynamics and tumor necrosis factor-α（ TNF-α）,interleukin 6（ IL-6） and interleukin 8（ IL-8） of the patients with sepsis were observed. Results The CPIS and APACHEⅡ values were significantly reduced after hemofiltration than those before（ P〈0. 05）. The TNF-α,GPT,serum albumin,IL-6,IL-8,hemameba,blood platelet,blood glucose,serum creatinine,mean arterial pressure（ MAP）,PaO2/FiO2 and central venous pressure（ CVP） had statistically significant difference before and after the treatment（ P〈0. 05）. Conclusion Hemofiltration on organ failure and systemic inflammation of patients with serious sepsis has remarkable effect,which can significantly reduce serum inflammatory factors,promote the balance of electrolyte in serum,inhibit the progression of systemic inflammatory response,improve patients with systemic hemodynamics and prognosis.