CBP和IBP治疗腹腔感染合并腹腔高压的疗效比较

Comparison of Therapeutic Effects of CBP and IBP on Intra-Abdominal Infection and Hypertension

目的:探讨持续性血液净化(CBP)和间断性血液净化(IBP)治疗腹腔感染合并腹腔高压(IAH)患者的疗效。方法:47例腹腔感染合并IAP患者随机分为CBP组(n=21)和IBP组(n=26),2组患者在常规治疗基础上均给予连续性静脉-静脉血液滤过和血液灌流,CBP组连续治疗(48±12)h,IBP组连续治疗(8±2)h、间隔24 h再次进行,共治疗3次;收集2组患者治疗前及治疗结束后APACHEⅡ评分及序贯器官衰竭评分(SOFA评分),检测血清降钙素原(PCT)、白细胞介素6(IL-6)、C反应蛋白(CRP)、动脉血乳酸(Lac)和乳酸清除率,观察IAP变化、胃肠道功能恢复时间、ICU停留时间及28 d死亡情况。结果:2组患者治疗后PCT、IL-6、CRP、Lac、IAP、SOFA评分及APACHEⅡ评分均较治疗前降低,差异均有统计学意义(P<0.05);2组患者间治疗后乳酸清除率、IAP、SOFA评分及APACHEⅡ评分比较,差异有统计学意义(P<0.05)。结论:CBP与IBP对腹部创伤和外科急腹症术后腹腔感染并IAP治疗均有效,CBP治疗对器官功能维护优于IBP治疗,但2种治疗方法对临床结局的影响无差异。

Objective:To explore the efficacy of continuous blood purification(CBP)and intermittent blood purification(IBP)in the treatment of patients with intra-abdominal infection and intra-abdominal hypertension(IAH).Methods:Forty-seven patients with intra-abdominal infection and IAP(intra-abdominal pressure)were randomly divided into CBP group(n=21)and IBP group(n=26).Both groups were given continuous vein-vein hemofiltration and hemoperfusion(CVVH+HP)on the basis of conventional treatment.The CBP group received continuous treatment(48±12)h;the group of IBP was treated for(8±2)h continuously and conducted the treatment again after 24-h interval for a total of 3 treatments.The score of APACHE(acute pathologic and chronic health evaluationⅡ)and sepsis related organ failure assessment(SOFA)were collected before and after treatment between the two groups.The serum procalcitonin(PCT),interleukin 6(IL-6),C-reactive protein(CRP),arterial blood lactic acid(Lac)and lactic acid clearance rate were measured.IAP changes,recovery time of gastrointestinal function,ICU staying,and 28 days of death status were observed.Results:The PCT,IL-6,CRP,Lac,IAP,SOFA score,and APACHEⅡscore of patients were all lower than before treatment,and the differences were statistically significant(P<0.05).The lactic acid clearance rate,IAP,SOFA score,and APACHEⅡscore were compared between the two groups,and the difference was statistically significant(P<0.05).Conclusions:CBP and IBP are effective in treating abdominal trauma and postoperative abdominal infection with IAP.CBP is better than IBP for organ function maintenance,but the two treatment methods have no difference in clinical outcome.