早期连续血液滤过对重症脓毒症患者影响的临床研究

Therapeutic effects of early continuous hemofiltration on severe sepsis

目的评价早期连续应用血液滤过技术治疗重症脓毒症患者的临床疗效。方法将符合纳入标准的63例患者随机分为血液滤过组32例和基础治疗组31例,血液滤过组在基础治疗组的基础上加用24 h连续血液滤过治疗技术,分析2组治疗前、治疗后72 h炎症指标变化[血清降钙素原(PCT)、C-反应蛋白(CRP)、IL-6、IL-10]、血流动力学变化(心率、平均动脉压、氧合指数)、APACHE Ⅱ评分变化。结果 2组治疗后72 h炎症指标除IL-10变化差异无统计学意义(P>0.05),其他指标(PCT、CRP、IL-6)均较治疗前有明显改善,差异有统计学意义(P<0.05)。2组比较血液滤过组PCT、CRP、IL-6的降低程度远高于基础治疗组,差异有统计学意义(P<0.05);血流动力学变化(心率、平均动脉压、氧合指数)均较治疗前改善(P<0.05),其中氧合指数组间比较差异有统计学意义(P<0.05),血液滤过组明显优于基础治疗组;2组APACHEⅡ评分组内前后比较差异有统计学意义(P<0.05),组间比较血液滤过组评分明显低于基础治疗组(P<0.05)。结论早期采用连续性血液滤过的疗法治疗人群重症脓毒症,能更有效清除炎症因子,改善机体的氧合功能,维持机体血流动力学稳定。

Objective To evaluate the clinical curative effects of early continuous hemodilution on severe sepsis.Methods Sixty-three patients with severe sepsis were randomly divided into early hemofiltration group(n=32)and basal therapy group(n=31).The patients in basal therapy group were treated by conventional basic treatment,however,the patients in early hemofiltration treatment group,on the basis of basal therapy group,were treated by 24-hour continuous hemofiltration.The changes of PCT,CRP,IL-6,IL-10,hemodynamics indexes including heart rate,mean arterial pressure,oxygenation index and APACHEⅡscore before treatment and at 72 hours after treatment were observed and compared between two groups.Results After treatment there were no significant differences in inflammatory indexes except for IL-10 at 72 hours after treatment between two groups(P>0.05),however,the other indexes including PCT,CRP and IL-6 were significantly improved in both groups,as compared with those before treatment(P<0.05).The levels of PCT,CRP and IL-6 in early hemofiltration group were significantly lower than those in basal therapy group(P<0.05).Moreover the changes of hemodynamics indexes including heart rate,mean arterial pressure and oxygenation index were significantly improved in both groups,as compared with those before treatment(P<0.05),in which,there was significant difference in oxygenation index between two groups(P<0.05),which in early hemofiltration group was superior to that in basic treatment group.In addition the APACHEⅡscores in early hematofilter group were significantly lower than those in basic treatment group(P<0.05).Conclusion The early continuous hemofiltration in treatment of severe sepsis can effectively remove inflammatory factors,improve the oxygenation function and stabilize the hemodynamics of the body.