序贯血液净化对严重创伤合并MODS患者炎性因子以及血流动力学的影响

Effect of Sequential Blood Purification on Inflammatory Factors and Hemodynamics in Patients with Severe Trauma Complicated with MODS

目的:探讨序贯血液净化(SBP)对严重创伤合并多器官功能障碍综合征(MODS)患者血清炎性因子及血流动力学的影响。方法:选取2015年7月-2017年5月第三军医大学新桥医院收治的严重创伤合并MODS患者48例,根据患者的治疗方式分为对照组21例以及观察组27例,其中对照组接受常规内科治疗,观察组在对照组的基础上进行SBP治疗,在治疗前后对两组患者的肝肾功能、血清炎性因子水平、血流动力学指标进行检测,并对比两组患者ICU住院时间、病死率、机械通气时间。结果:治疗后两组患者的总胆红素(TBIL)、直接胆红素(DBIL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、血尿素氮(BUN)、肌酐(Cr)水平均较治疗前降低,且治疗后观察组患者各指标低于对照组(P<0.05);治疗后两组患者血清C反应蛋白(CRP)、白介素-6(IL-6)、白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平均较治疗前显著降低,且治疗后观察组患者各炎性因子水平显著低于对照组(P<0.05);治疗后两组患者的心率(HR)、中心静脉压(CVP)较治疗前降低,平均动脉压(MAP)、心脏指数(CI)较治疗前升高,且治疗后观察组患者的HR、CVP显著低于对照组,MAP、CI显著高于对照组(P<0.05);观察组患者的ICU住院时间、机械通气时间均较对照组缩短,病死率较对照组明显降低(P<0.05)。结论:SBP应用于严重创伤合并MODS患者的治疗可以有效减轻患者的炎性反应,并可以显著改善患者血流动力学以及预后。

Objective： To investigate the effect of sequential blood purification （SBP） on serum inflammatory factors and hemody- namics in patients with severe trauma complicated with multiple organ dysfi.mction syndrome （MODS）. Methods： A total of 48 patients with severe trauma complicated with MODS, who were admitted to the Third Military Medical University Xinqiao Hospital during July 2015 to May 2017, were selected and divided into observation group（n=27） and control group（n=21）. The control group was given routine medical treatment, the observation group was treated with SBP on the basis of the control group＇s therapy. The liver and kidney fi.mction, serum levels of inflammatory cytokines, hemodynamic indexes of the two groups of patients were detected before and after therapy. The ICU length of hospital stay, mortality, mechanical ventilation time of the two groups of patients were compared. Results： After treatment, the levels of total bilirubin （TBIL）, direct bilirubin （DBIL）, aspartate aminotransferase （AST）, alanine aminotransferase （ALT）, blood urea nitrogen （BUN）, creatinine （Cr） of the two groups of patients decreased than those before treatment, and the indexes of the ob- servation group were lower than those of the control group; serum C reactive protein （CRP）, Interleukin -6 （IL-6）, interleukin -1 beta （IL-1 beta）, tumor necrosis factor alpha （TNF- alpha） levels of the two groups of patients were significantly lower than those before treatment, and the inflammatory factors of the observation group were lower than those of the control group （P〈0.05）. After treatment, heart rate （HR）, central venous pressure （CVP） decreased than those before treatment; mean arterial pressure （MAP） and cardiac index （CI） were higher than those before treatment, and the indexes of the observation group were higher than those of the control group （P〈0.05）. The ICU hospitalization time and mechanical ventilation time of the patients in the observation group was shorter than that in the control group, and the mortality rate was significantly lower than that in the control group （P〈0.05）. Conclusion： In the treatment of patients with severe trauma complicated with MODS, SBP can effectively reduce the inflammatory response of patients and significantly improve the hemodynamics and the prognosis of the patients.