连续性血浆滤过吸附治疗重度烧伤脓毒症患者的效果

Effect of continuous plasma filtration adsorption on treatment of severely burned patients with sepsis

目的探讨连续性血浆滤过吸附治疗重度烧伤脓毒症患者的效果。方法2014年1月—2017年9月，笔者单位收治86例符合入选标准的重度烧伤脓毒症患者，按照随机数字表法分为常规治疗组和连续性血浆滤过组，每组各43例。常规治疗组患者入院后采用常规治疗，连续性血浆滤过组患者在常规治疗组治疗基础上于入院后第2天应用血液滤过器、血液净化机、血浆分离器进行连续性血浆滤过吸附治疗。2组患者疗程均为7 d。比较2组患者治疗总有效率，治疗前、后白细胞计数（WBC）、尿素氮、血肌酐、中性粒细胞CD64、降钙素原（PCT）和C反应蛋白（CRP）变化，治疗后28 d病死率。结果（1）连续性血浆滤过组患者治疗总有效率为88.37%（38/43），明显高于常规治疗组的65.12%（28/43），χ2＝6.515，P＝0.018。（2）连续性血浆滤过组患者治疗后WBC、尿素氮、血肌酐、中性粒细胞CD64、PCT和CRP明显低于常规治疗组（t＝6.305、4.420、18.537、13.435、12.975、14.234，P〈0.05）。2组患者治疗后WBC、尿素氮、血肌酐、中性粒细胞CD64、PCT和CRP明显低于治疗前（t＝9.459、9.130、25.438、35.467、23.471、23.601、3.802、5.662、12.067、25.694、20.720、12.437，P〈0.01）。（3）治疗后28 d，连续性血浆滤过组患者病死率为6.98%（3/43），明显低于常规治疗组的25.58%（11/43），χ2＝5.460，P＝0.023。结论连续性血浆滤过吸附治疗重度烧伤脓毒症患者效果显著，可减轻由炎症因子介导的炎症反应，预后良好。

ObjectiveTo investigate effect of continuous plasma filtration adsorption on treatment of severely burned patients with sepsis.MethodsIn January 2014 to September 2017, 86 severely burned patients with sepsis, conforming to the study criteria, were admitted to our hospital and divided into into routine treatment group and continuous plasma filtration group according to the random number table method, with 43 patients in each group. Patients in routine treatment group were treated with routine treatment after admission. Patients in continuous plasma filtration group were treated with blood filter, blood purification machine, and plasma separator for continuous plasma filtration adsorption on the basis of the routine treatment group on the second day after admission. The course of treatment in the 2 groups was 7 d. The total effective treatment rate, changes of leukocyte count （WBC）, usea nitrogen, serum creatinine, neutrophile CD64,procalcitonin, and C reactive protein （CRP） before and after treatment, and mortality on 28 days after treatment of patients in 2 groups were analyzed and compared.Results（1） The total effective treatment rate of patients in continuous plasma filtration group was 88.37% （38/43）, which was significantly higher than that of the routine treatment group [65.12% （28/43）, χ2=6.515, P=0.018]. （2） After treatment, WBC, urea nitrogen, serum creatinine, neutrophils CD64, procalcitonin, and CRP of patients in continuous plasma filtration group were significantly lower those in routine treatment group （t=6.305, 4.420, 18.537, 13.435, 12.975, 14.234, P〈0.05）. WBC, urea nitrogen, serum creatinine, neutrophile CD64, procalcitonin, and CRP of patients in 2 groups after treatment were significantly lower than those before treatment （t=9.459, 9.130, 25.438, 35.467, 23.471, 23.601, 3.802, 5.662, 12.067, 25.694, 20.720, 12.437, P〈0.05）. （3） On 28 days after treatment, mortality of patients in continuous plasma filtration group was 6.98% （3/43）, which was significantly lower than that in routine treatment group [25.58% （11/43）], χ2=5.460, P=0.023.ConclusionsContinuous plasma filtration adsorption is effective in treating severely burned patients with sepsis, which can alleviate inflammatory reaction mediated by inflammatory cytokine with good prognosis.