持续性血液净化技术对重症脓毒症患者炎性因子、免疫功能及预后的影响

Effect of Continuous Blood Purification on Inflammatory Factors,Immune Function and Prognosis in Patients with Severe Sepsis

目的:探讨持续性血液净化技术(Continuous blood purification,CBP)对重症脓毒症患者炎性因子、免疫功能及预后的影响。方法:回顾性分析于2016年2月—2018年2月郑州大学第五附属医院收治的120例重症脓毒性患者的临床资料,根据治疗方法不同,分为观察组(58例,常规治疗)和对照组(62例,常规治疗+持续性血液净化技术)。对比两组炎性因子水平及外周血T淋巴细胞亚群水平,分析两组患者预后情况。结果:治疗后1个月,对照组IL-1、TNF-α水平高于观察组,IL-10水平低于观察组(P<0.05);治疗后1一个月,观察组CD4+水平与CD4+/CD8+升高更明显,CD8+水平下降更明显(P<0.05);观察组治疗后总并发症(肝衰竭、急性呼吸窘迫综合征、心力衰竭)发生率为6.90%明显低于对照组的19.35%(P<0.05);观察组ICU住院时间、30天内死亡率均低于对照组,机械通气时间短于对照组(P<0.05);治疗后观察组APACHEⅡ评分明显低于对照组(P<0.05)。结论:CBP治疗方案运用于重症脓毒症患者可取得较为理想的临床治疗效果,该方案可改善患者体内炎性因子水平及免疫功能,利于患者预后。

Objective: To explore the effect of continuous blood purification(CBP) on inflammatory factors, immune function and prognosis of patients with severe sepsis. Methods: The clinical data of 120 patients with severe sepsis admitted to the hospital from February 2016 to February 2018 were retrospectively analyzed. According to different treatments, they were divided into observation group(58 cases, conventional treatment) and control group(62 cases, conventional treatment + continuous blood purification). The levels of inflammatory factors and peripheral blood T lymphocyte subsets were compared between the two groups, and the prognosis of patients between the two groups was analyzed. Results: One month after treatment, the level of IL-1 and TNF-α in the control group was higher than that in the observation group, and the level of IL-10 was lower than that in the observation group(P<0.05). One month after treatment, the CD4+ level and CD4+/CD8+ level of the observation group increased significantly, and the CD8+ level decreased more significantly(P<0.05). The incidence of total complications(liver failure, acute respiratory distress syndrome, heart failure) in the observation group after treatment was 6.90%, which was significantly lower than 19.35% in the control group(P<0.05). The length of ICU stay in the observation group and the mortality rate within 30 days were lower than those in the control group, and the mechanical ventilation time was shorter than that of the control group(P<0.05). After treatment, the APACHE Ⅱ score of the observation group was significantly lower than that of the control group(P<0.05). Conclusion: The application of CBP therapy to patients with severe sepsis can achieve a relatively ideal clinical treatment effect. This program can improve the level of inflammatory factors and immune function in the patient, and is beneficial to the prognosis of the patient.