连续性静脉-静脉血液滤过联合血液灌流治疗ICU脓毒症患者的效果观察

Observation on the Effect of Continuous Venous-venous Hemofiltration Combined with Hemoperfusion in the Treatment of Patients with Sepsis in ICU

目的观察连续性静脉-静脉血液滤过联合血液灌流治疗ICU脓毒症的效果。方法选择2016年2月-2019年8月收治于我院ICU的87例脓毒症患者作为研究对象,将其随机分成对照组(43例)和观察组(44例),常规治疗的基础上给予对照组患者连续性静脉-静脉血液滤过治疗(CVVH),观察组在对照组基础上联合血液灌流治疗(CVVH+HP)。比较两组治疗前后实验室指标[白细胞计数(WBC)、血红蛋白(Hb)、尿素氮(BUN)、血肌酐(Scr)、血乳酸(LAC)、超敏C反应蛋白(hs-CRP)]、尿量、炎性因子水平[白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子(TNF-α)]、ICU住院时间、总住院时间及死亡率。结果治疗后两组WBC、Hb、BUN、Scr、LAC、hs-CRP均较治疗前降低,尿量较治疗前升高,所有指标均得到改善,且观察组改善优于对照组,差异有统计学意义(P<0.05);治疗后两组IL-6、IL-8及TNF-α炎性因子水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);观察组ICU住院时间、总住院时间及死亡率均低于对照组,差异有统计学意义(P<0.05)。结论在常规治疗的基础上,采用连续性静脉-静脉血液滤过联合血液灌流治疗ICU脓毒症,可有效改善患者的实验室指标及尿量、降低炎性因子水平、缩短住院时间,降低死亡率,值得临床应用。

Objective To observe the effect of continuous venous-venous hemofiltration combined with hemoperfusion in the treatment of sepsis in ICU.Methods 87 patients with sepsis admitted to the ICU of our hospital from February 2016 to August 2019 were selected as the research objects.They were randomly divided into a control group(43 cases)and an observation group(44 cases).On the basis of conventional treatment,patients in the control group were given continuous venous-venous hemofiltration(CVVH).The observation group was combined with hemoperfusion therapy(CVVH+HP)on the basis of the control group.Compare the two groups of laboratory indicators before and after treatment[white blood cell count(WBC),hemoglobin(Hb),urea nitrogen(BUN),blood creatinine(Scr),blood lactic acid(LAC),high sensitivity C-reactive protein(hs-CRP)],Urine volume,levels of inflammatory factors[interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor(TNF-α)],length of stay in ICU,total length of stay and mortality.Results After treatment,WBC,Hb,BUN,Scr,LAC,hs-CRP in the two groups were lower than before treatment,and urine output was higher than before treatment.All indicators were improved,and the improvement of the observation group was better than that of the control group,the difference was statistically significant(P<0.05);After treatment,the levels of IL-6,IL-8 and TNF-αinflammatory factors in the two groups were lower than before treatment,and the observation group was lower than the control group,the difference was statistically significant(P<0.05);The length of stay in ICU,total length of hospital stay,and mortality in the observation group were lower than those in the control group,the difference was statistically significant(P<0.05).Conclusion On the basis of conventional treatment,continuous venous-venous hemofiltration combined with hemoperfusion is used to treat ICU sepsis.It can effectively improve the patient's laboratory indicators and urine output,reduce the level of inflammatory factors,shorten the hospital stay,and reduce the mortality rate.It is worthy of clinical application.