连续性血液净化对脓毒症休克并发ARDS患者炎性因子及预后的影响

Effect of continuous blood purification on inflammatory factors and prognosis in patients with septic shock complicated with ARDS

目的探讨连续性血液净化对脓毒症休克并发急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者炎性因子及预后的影响。方法选择本院2016年12月至2018年12月收治的脓毒症休克并发ARDS患者82例为研究对象,按照随机数表法将其分为对照组与观察组,每组各41例。两组患者入院后均采取常规治疗,观察组患者在常规治疗基础上于入院后12 h内进行连续性血液净化治疗。比较两组患者治疗前和治疗后24 h急性生理功能与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分、血流动力学变[包括心率、中心静脉压(central venous pressure,CVP)及平均动脉压(mean arterial pressure,MAP)]、炎性因子水平[白介素-6(interleukin-6,IL-6)、白介素-10(interleukin-10,IL-10)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]变化及入院28 d预后情况。结果治疗后,两组患者APACHEⅡ评分、SOFA评分、心率、血清IL-6和TNF-α水平均显著低于本组治疗前(P_均<0.05),CVP、MAP及血清IL-10水平均显著高于本组治疗前(P_均<0.05);且观察组患者APACHEⅡ评分、SOFA评分、心率、血清IL-6和TNF-α水平均显著低于对照组(P_均<0.05),CVP、MAP及血清IL-10水平均显著高于对照组(P_均<0.05)。观察组患者入院28 d死亡率为19.51%(8/41),显著低于对照组[48.78%(20/41)](χ~2=7.810,P <0.05)。结论连续性血液净化对脓毒症休克并发ARDS患者效果良好,可减轻患者炎性反应,改善预后,值得临床借鉴。

Objective To investigate the effect of early continuous blood purification on inflammatory factors and prognosis in patients with septic shock complicated with acute respiratory distress syndrome(ARDS).Method 82 patients with septic shock complicated with ARDS admitted to our hospital from December 2016 to December 2018 were selected as the objects.According to the random table number method,they were divided into control group and observation group,41 case in each group.Both groups received routine treatment after admission,patients in observation group were treated with continuous blood purification within 12 hours after admission on the basis of routine treatment.The changes of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores,sequential organ failure assessment(SOFA)scores,hemodynamics [including heart rate,central venous pressure(CVP),mean arterial pressure(MAP)],inflammatory factors [interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)] before treatment and 24 h after treatment and 28-day prognosis after admission were compared between the two groups.Result After treatment,APACHEⅡ scores,SOFA scores,heart rate,serum IL-6 and TNF-α levels in both groups were significantly lower than those before treatment(Pall<0.05),CVP,MAP and serum IL-10 levels were significantly higher than those before treatment(Pall<0.05),and APACHEⅡ score,SOFA score,heart rate,serum IL-6 and TNF-α levels in observation group were significantly lower than those in control group(Pall<0.05),CV,MAP and IL-10 levels were significantly higher than those in control group(Pall<0.05).The 28-day mortality rate of observation group was 19.51%(8/41),which was significantly lower than that in control group [48.78%(20/41)](χ^2=7.810,P<0.05).Conclusion Early continuous blood purification has a good effect on septic shock complicated with ARDS.It can alleviate inflammation and improve prognosis,which is worthy of clinical reference.