血毒清联合杂合肾脏替代治疗对重症脓毒症的疗效、血流动力学和预后干预作用的研究

Effects of Xueduqing combined with hybrid renal replacement therapy on the efficacy,hemodynamics and prognosis of patients with severe sepsis

目的探讨血毒清联合杂合肾脏替代治疗(HRRT)重症脓毒症的效果及对血流动力学、预后的影响。方法选取2017年3月至2019年8月十堰市太和医院重症脓毒症患者135例,在常规治疗基础上,按简单随机化法分为血毒清组、HHRT组和血毒清联合HRRT组(联合组),每组45例,治疗5 d。治疗前和治疗5 d后序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分系统Ⅱ评分(APACHEⅡ)、炎症因子指标[白细胞介素-10(IL-10)、IL-6、降钙素原(PCT)、C反应蛋白(CRP)]水平、血流动力学指标[全身血管阻力指数(SVRI)、血管外肺水指数(EVLWI)、胸腔内血容积指数(ITBVI)、心指数(CI)]及重症监护室(ICU)住院时间比较采用配对t检验,多组间差异采用方差分析,组间两两比较采用LSD-t检验,3组28 d病死率采用χ^2检验。结果治疗5 d后,与联合组比较,HHRT组和血毒清组SOFA评分[(4.29±1.17)分比(6.15±1.39)分、(7.03±1.52)分]、APACHEⅡ评分[(11.68±2.12)分比(14.26±3.04)分、(15.17±2.85)分]、血清IL-10[(36.61±6.50)μg/L比(42.75±7.42)μg/L、(45.06±8.37)μg/L]、IL-6[(130.26±41.04)pg/mL比(169.84±46.75)pg/mL、(178.36±50.91)pg/mL]、PCT[(0.87±0.29)ng/mL比(1.96±0.47)ng/mL、(2.24±0.53)ng/mL]、CRP[(34.93±9.71)mg/L比(51.67±10.32)mg/L、(56.79±11.82)mg/L]、EVLWI[(4.12±1.38)mL/kg比(5.38±1.69)mL/kg、(6.04±1.85)mL/kg]降低,而SVRI[(2079.54±124.75)dyn·s·cm^-5·m^2比(1865.37±109.38)dyn·s·cm^-5·m^2、(1796.28±131.75)dyn·s·cm^-5·m^2]、ITBVI[(1189.40±92.36)mL/m^2比(986.97±75.32)mL/m^2、(902.37±68.64)mL/m^2]、CI[(4.26±0.65)L·min^-1·m^-2比(3.83±0.58)L·min^-1·m^-2、(3.67±0.53)L·min^-1·m^-2]均升高,差异均有统计学意义(P<0.05)。与联合组比较,HHRT组和血毒清组ICU住院时间[(14.82±4.40)d比(17.20±3.47)d、(18.46±4.25)d]缩短(P<0.05)。结论血毒清联合HRRT治疗重症脓毒症,对减少炎性因子水平,调节血流动力学具有一定作用,能够缩短ICU住院时间。

Objective To explore the effect of Xueduqing combined with hybrid renal replacement therapy(HRRT)on severe sepsis and its impact on hemodynamics and prognosis.Methods From March 2017 to August 2019,according to simple randomization,135 patients with severe sepsis in our hospital were divided into HRRT combined Xueduqing group(n=45),HHRT group(n=45)and Xueduqing group(n=45).After conventional treatment,patients in three groups received HHRT,Xueduqing,Xueduqing combined with HRRT for 5 days,respectively.Before treatment and after 5-day treatment,t-test were used to value sequential organ failure score(SOFA),acute physiology and chronic health status scoring systemⅡscore(APACHEⅡ),blood inflammatory factor indicators[interleukin-10(IL-10),IL-6,procalcitonin(PCT).C-reactive protein(CRP)]levels,hemodynamic indicators[systemic vascular resistance index(SVRI),as well as extravascular lung water index(EVLWI),intrathoracic blood volume index(ITBVI),cardiac index(CI)]were tested by t test.Analysis of variance was used to analyze the differences among groups,and LSD-t test was used for pairwise comparison between groups.Length of intensive care unit(ICU)hospitalization of three groups were tested by t test,the 28-day mortality rate of the three groups examined by χ^2 test.Results(1)After 5-day treatment,the SOFA score[(4.29±1.17)points]and APACHE II score[(11.68±2.12)points]in the HRRT combined with Xueduqing group were lower than those in the HHRT group[(6.15±1.39)points,(14.26±3.04)points],Xueduqing group[(7.03±1.52)points,(15.17±2.85)points](P<0.05);(2)The serum IL-10[(36.61±6.50)μg/L],IL-6[(130.26±41.04)pg/mL],PCT[(0.87±0.29)ng/mL],CRP[(34.93±9.71)mg/L]of the HRRT combined Xueduqing group were lower than those of the HHRT group[(42.75±7.42)μg/L,(169.84±46.75)pg/mL,(1.96±0.47)ng/mL,(51.67±10.32)mg/L],Xueduqing group[(45.06±8.37)μg/L,(178.36±50.91)pg/mL,(2.24±0.53)ng/mL,(56.79±11.82)mg/L](P<0.05);(3)After 5-day treatment of HRRT combined with Xueduqing group,SVRI[(2079.54±124.75)dyn·s·cm-5·m2],ITBVI[(1189.40±92.36)mL/m2],CI[(4.26±0.65)L·min^-1·m^-2]were higher than HHRT group[(1865.37±109.38)dyn·s·cm^-5·m^2,(986.97±75.32)mL/m^2,(3.83±0.58)L·min^-1·m^-2],Xueduqing group[(1796.28±131.75)dyn·s·cm^-5·m^2,(902.37±68.64)mL/m^2,(3.67±0.53)L·min^-1·m^-2],EVLWI[(4.12±1.38)ml/kg]was lower than HHRT group[(5.38±1.69)mL/kg],Xueduqing group[(6.04±1.85)mL/kg](P<0.05);(4)The ICU hospital stay in the HRRT combined with Xueduqing group[(14.82±4.40)d]was shorter than that in the HHRT group[(17.20±3.47)d],Xueduqing group[(18.46±4.25)d](P<0.05).Conclusion Xueduqing combined with HRRT therapy has a certain effect on reducing the inflammatory factors,regulating hemodynamics in the treatment of severe sepsis,and thus shorten the ICU hospital stay.