高容量血液滤过治疗对重症感染性休克合并肾功能障碍患者循环水平及免疫功能的影响

Effects of high-volume hemofiltration on circulation and immune function in patients with severe septic shock combined with renal dysfunction

目的分析高容量血液滤过(HVHF)治疗对重症感染性休克合并肾功能障碍患者循环水平及免疫功能的影响。方法将2017年2月-2019年2月成都市第二人民医院重症监护室住院的116例重症感染性休克合并肾功能障碍患者,随机数字表法分为分照组(57例)和观察组(59例),对照组采用液体复苏常规治疗,观察组在液体复苏6 h内再实施HVHF治疗。观察两组患者治疗后的临床疗效,循环水平和免疫功能。结果治疗前两组全身多器官功能障碍(multiple organdysfunction,MODS)评分、急性生理与慢性健康(APACHEⅡ)评分、尿量、血尿素氮(BUN)含量、血清血肌酐(Scr)水平、血清钾(K^+)、肿瘤坏死因子(TNF-α)水平、C反应蛋白(CRP)水平、降钙素原(PCT)水平、血压调整性心率(PAR)值、动脉血氧分压(PaO2)值、氧合指数(PaO2/FiO2)值、二氧化碳结合能力(CO2CP)值及免疫功能CD3^+、CD4^+、CD8^+和CD4^+/CD8^+差异均无统计学意义(P>0.05);治疗后观察组MODS评分、APACHEⅡ评分、BUN含量、Scr水平、血清K^+、TNF-α水平、CRP水平、PCT水平明显低于对照组,且差异有统计学意义(P<0.05);PAR值、PaO2值、PaO2/FiO2值、CO2CP值和CD3^+、CD4^+、CD4^+/CD8^+均明显高于对照组,且差异有统计学意义(P<0.05)。结论HVHF治疗重症感染性休克合并肾功能障碍患者比单纯液体复苏治疗临床疗效更好,HVHF可保护重症感染性休克合并肾功能障碍患者的肾功能,改善血流动力学和增强免疫功能的作用。

Objective To analyze the effects of high-volume hemofiltration(HVHF)on the circulating level and immune function in patients with severe septic shock combined with renal dysfunction.Methods One hundred and sixteen patients with severe septic shock and renal dysfunction admitted to intensive care unit in Chengdu Second People's Hospital from February 2017 to February 2019 were randomly divided into the control group(57 cases)and the observation group(59 cases).The control group was treated with conventional fluid resuscitation,and the observation group was treated with HVHF within 6 hours of fluid resuscitation.The clinical efficacy,circulating level and immune function of patients in two groups were observed.Results There were no statistical differences in multiple organdysfunction(MODS)score,acute physiology and chronic health(APACHEⅡ)score,urine volume,blood urea nitrogen(BUN),serum creatinine(Scr)level,and serum potassium(K^+),tumor necrosis factor-(TNF-α)levels,C-reactive protein(CRP)levels,procalcitonin(PCT)levels,blood pressure-adjusted heart rate(PAR)values,arterial oxygen pressure(PaO2)values,oxygenation index(PaO2/FiOJ value,carbon dioxide binding capacity(CO2CP)value,and immune function CD3^+,CD4^+,CD8^+,and CD4V CD8(P>0.05);MODS,APACHEⅡ,BUN,Scr,serum K^+,TNF-α,CRP,and PCT in the observation group after treatment were significantly lower than those in the control group,and the differences were statistically significant(P<0.05);PAR,PaO2,PaO2/FiO2,CO2CP and GD3^+,CD4^+,CD4^+/CD8^+were significantly higher than those in the control group(P<0.05).Conclusion HVHF is more effective in the treatment of patients with severe septic shock and renal dysfunction than fluid resuscitation alone.HVHF can protect the renal function of patients'with severe septic shock and renal dysfunction,improve hemodynamics and enhance immune function.