床旁持续血液滤过联合血液灌流治疗感染性休克患者的效果及对血流动力学和炎性因子的影响

Effects of Continuous Bedside Hemofiltration Combined with Hemoperfusion on Hemodynamics and Inflammatory Factors in Patients with Septic Shock

目的探讨床旁持续血液滤过联合血液灌流治疗感染性休克患者的效果及对血流动力学和炎性因子的影响。方法选取感染性休克患者70例,按照随机数字表法随机分成对照组和观察组,每组35例。对对照组患者予以床旁持续血液滤过(CRRT)治疗,观察组患者在予以CRRT治疗的基础上联合予以血液灌流(HP)治疗。治疗后分别对两组患者的临床疗效、血液流动力学变化、炎性因子水平、ICU住院时间以及病死率进行比较。结果治疗后观察组患者的呼吸频率、心率以及血清乳酸水平明显低于对照组患者;观察组患者的全血黏度高切、中切和低切、纤维蛋白原、红细胞压积以及血液黏度水平均显著低于对照组患者(P<0.05);观察组患者的血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)水平均显著低于对照组患者,差异有统计学意义(P<0.05);观察组患者的ICU住院时间、机械通气时间以及病死率均显著少于对照组患者,差异有统计学意义(P<0.05)。结论采用床旁CRRT联合HP对感染性休克患者进行治疗,能够有效改善患者的血液流变学情况,降低机体炎症水平,缩短平均机械通气时间和住院时间,取得显著的临床治疗效果。

Objective To investigate the effects of continuous bedside hemofiltration combined with hemoperfusion on hemodynamics and inflammatory factors in patients with septic shock.Methods Seventy patients with septic shock admitted to our hospital from February 2017 to January 2019 were randomly divided into control group and observation group(n=35).Patients in the control group were treated with continuous renal replacement therapy(CRRT);while those in observation group were treated with CRRT and hemoperfusion.After treatment,the clinical efficacy,hemodynamic changes,levels of inflammatory factors,ICU hospitalization time and mortality were compared between the two groups.Results Respiratory frequency,heart rate and serum lactic acid level in the observation group were significantly lower than those in control group.The whole blood viscosity,fibrinogen,hematocrit and blood viscosity in the observation group were significantly lower than those in control group(P<0.05).The levels of serum C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-1(IL-1),interleukin-6(IL-6),interleukin-10(IL-10)in the observation group were significantly lower than control group(P<0.05).The ICU hospitalization time,mechanical ventilation time and fatality rate in the observation group were significantly less than those in the control group(P<0.05).Conclusion Bedside continuous hemofiltration combined with hemoperfusion can effectively improve the hemorheology of patients with septic shock,reduce the level of inflammation,shorten the average time of mechanical ventilation and hospitalization,and achieve significant clinical therapeutic effect.