连续性血液净化对小儿脓毒症患者血清抗凝血酶Ⅲ白细胞介素-6及D-二聚体的影响

Effect of continuous blood purification on serum antithrombinⅢ,interleukin-6 and D-dimer levels in children with sepsis

目的 分析连续性血液净化对小儿脓毒症患者血清抗凝血酶Ⅲ,白细胞介素(IL)-6及D-二聚体水平的影响.方法 选取2016年6月至2018年6月于我院收治的小儿脓毒症患者50例作为研究对象,将样本按随机数字表法分成对照组与观察组,每组25例.所有患者均给予一般的对症治疗,其中对照组应用低分子肝素钙,观察组则在对照组的基础上增加床旁血滤机对患者实施连续性血液净化的疗法.在疗程结束对2组患儿的血清抗凝血酶Ⅲ,IL-6及D-二聚体水平进行研究.结果 观察组的临床治疗总有效率为92%,而对照组仅为68%,差异有统计学意义(P<0.05);在经过治疗后,IL-6与D-二聚体水平呈下降趋势,其抗凝血酶Ⅲ水平升高,差异有统计学意义(P<0.05),观察组患儿在治疗过程中其不良反应发生为8%,对照组为24%,差异无统计学意义(P>0.05);经过治疗后,2组患儿的CD4^+、CD8^+、CD4^+/CD8^+水平呈上升趋势,差异有统计学意义(P<0.05),观察组的CD4^+、CD8^+、CD4^+/CD8^+水平比对照组高.结论 当前在临床治疗小儿脓毒症时在对照组疗法的基础上增加连续性血液净化的治疗方法,可以达到有效的治疗目的,取得良好治疗效果,原因可能与下调血清IL-6与D-二聚体水平和上调抗凝血酶Ⅲ有密切关联.

Objective To determine the effect of continuous blood purification on serum antithrombinⅢ(AT-Ⅲ),interleukin-6(IL-6)and D-dimer(D-D)levels in children with sepsis.Methods Fifty children with sepsis admitted to our hospital between June 2016 and June 2018 were included as the subjects in the study.All patients were randomly divided into the control group and study group(n=25 each).All patients were given general symptomatic treatment.The control group was treated with low molecular heparin calcium.In addition,the study group was treated with continuous blood purification by bedside blood filter.At the end of the treatment,the serum antithrombinⅢ,IL-6 and D-D levels in the two groups were determined.Results The total effective rate of clinical treatment in the study group was 92%,while it was only 68%in the control group,with significant difference between the two groups(P<0.05).After the treatment,the levels of IL-6 and D-D showed a decreasing trend,and the level of antithrombinⅢincreased(P<0.05).The incidence of adverse reactions during the treatment in the study group and control group was 8%and 24%,respectively,with no statistical significance between the groups(P>0.05).After the treatment,the levels of CD4^+,CD8^+and CD4^+/CD8^+in the study group showed an increasing trend,with statistical significance(P<0.05).The levels of CD4^+,CD8^+and CD4^+/CD8^+in the study group were higher than those in the control group.Conclusion At present,continuous blood purification based on basic therapy maybe effective in the clinical treatment of pediatric sepsis.The reasons for good therapeutic effect are mostly closely related to down-regulation of serum IL-6 and D-D levels and up-regulation of AT-Ⅲ.