连续性静脉-静脉血液滤过联合血液灌流治疗严重烧伤脓毒症的临床研究

Clinical study of continuous veno-venous hemofiltration combined with hemoperfusion in the treatment of severe burn sepsis

目的:探讨连续性静脉-静脉血液滤过(CVVH)联合血液灌流(HP)是否能够清除严重烧伤脓毒症患者血清中的炎症细胞因子,从而减缓器官损害。方法:按随机原则将51例严重烧伤脓毒症患者分为常规CVVH治疗组(26例),CVVH+HP治疗组(25例)。CVVH治疗组连续采用CVVH治疗72 h,CVVH+HP治疗组采用HP 2 h+CVVH 22 h串联的模式治疗72 h。分别于治疗前及治疗后24、48和72 h进行抽血化验,ELISA方法检测血清中C反应蛋白水平,流式CBA方法检测炎症细胞因子的变化。并统计治疗前后SOFA评分变化幅度(△SOFA)、APACHEⅡ评分变化幅度(△APACHEⅡ)和28 d病死率。结果:治疗期间CVVH治疗组CRP水平没有明显变化P>0.05,CVVH+HP治疗组治疗72 h时CRP水平明显降低,与治疗前相比差异有统计学意义(P<0.05)。CVVH治疗组治疗72 h时IL-6和IL-8水平有明显降低,与治疗前比较差异有统计学意义(P<0.05);CVVH+HP治疗组在治疗24 h时IL-6和IL-8水平有明显降低,且治疗48 h和72 h持续降低,与治疗前比较差异均有统计学意义(P<0.05)。CVVH+HP治疗组△SOFA和△APACHEⅡ高于CVVH治疗组,组间差异有统计学意义(P<0.05),28 d病死率组间差异无统计学意义(P>0.05)。结论:CVVH单独治疗或CVVH联合HP治疗均能降低烧伤脓毒症患者血清IL-6、IL-8水平,缓解器官损伤,联合治疗效果更佳。

Objective:To investigate whether continuous veno-venous hemofiltration(CVVH)combined hemoperfusion(HP)could reduce serum inflammatory cytokine level and prevent organ injury in burn wound sepsis patients.Method:Fifty-one patients were randomly divided into two groups:CVVH group(n=26)and CVVH+HP group(n=25).Patients in the CVVH group were treated with CVVH for 72 hours continuously,and those in the CVVH+HP group were treated with HP 2 h+CVVH 22 h in tandem for 72 h.Serum c-reactive protein levels were detected by ELISA and inflammatory cytokines were detected by flow cytometry(FCM)before and 24,48 and 72 hours after treatment.The statistical variations in SOFA score(△SOFA)and APACHEⅡscore(△APACHEⅡ)before and after the treatment,and 28 d death rate were also observed.Result:During the treatment,there was no significant change in CRP level in the CVVH group(P>0.05).The CRP level in the CVVH+HP group was significantly reduced 72 h after treatment compared with that before treatment,and the difference was statistically significant(P<0.05).The levels of IL-6 and IL-8 in the CVVH group were significantly reduced 72 hours after treatment,and the differences were statistically significant compared with those before treatment(P<0.05).In CVVH+HP group IL-6 and IL-8 levels significantly decreased 24 h after treatment,and continuously decreased at 48h and 72h after treatment,with statistically significant differences compared with those before treatment(P<0.05).The△SOFA and △APACHEⅡ in CVVH+HP treatment group were both higher than those in the CVVH treatment group,both with statistically significant differences(P<0.05).The 28 d death rate between the two groups had no statistically significant difference(P>0.05).Conclusion:Both CVVH alone and CVVH combined with HP can reduce serum IL-6 and IL-8 levels and alleviate organ injury in patients with sepsis after burns,and the combination therapy is more effective.