静脉血液滤过模式血液净化联合血必净对脓毒症患者免疫功能和炎症因子的干预研究

A study on intervening immune function and inflammatory factors in patients with sepsis by CVVH mode blood purification plus the Xuebijing injection

目的:观察静脉血液滤过(Continuous Veno-venous Hemofiltration,CVVH)模式血液净化联合血必净注射液对脓毒症患者免疫功能和炎症因子的干预研究,探究血液净化联合血必净注射液改善脓毒症患者免疫状态的作用机制。方法:选取2018年1月-2019年12月贵州中医药大学第二附属医院重症医学科收治的符合脓毒症诊断标准的68例患者,采用随机数字表法将患者分为两组,其中观察组34例、对照组34例。对照组予常规抗感染、液体复苏、保护脏器功能、营养支持及CVVH模式血液净化治疗;观察组在对照组基础上联合血必净注射液50 mL静脉泵入,每日2次,1周为一个疗程。比较两组脓毒症患者治疗前后的急性生理与慢性健康评分表Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)评分,观察治疗周期前后降钙素原(Procalcitonin,PCT)、C反应蛋白(C-reactive Protein,CRP)、白细胞介素-6(Interleukin-6,IL-6)炎症因子水平,CD4+、CD8+等免疫指标及机械通气时间、撤机百分率、28天病死率。结果:两组患者APACHEⅡ评分治疗后较治疗前均有不同程度的下降,差异有统计学意义(P<0.05);而与对照组相比,观察组改善情况更为显著(P<0.05)。两组患者治疗后CRP、PCT、IL-6水平较前均有降低,而与对照组相比,观察组CRP、PCT、IL-6水平改善较为显著(P<0.05)。两组患者治疗后CD4+及CD4+/CD8+值较前均有不同程度升高,CD8+水平较前则有所下降(P<0.05);而与对照组比较,观察组的CD4+、CD8+及CD4+/CD8+值改善情况较为显著(P<0.05)。完成研究的患者中,撤机百分率为88.33%(53/60)。与对照组相比,观察组机械通气时间明显减少,差异有统计学意义(P<0.05)。观察组患者的28天病死率,与对照组相比,差异有统计学意义(P<0.05)。结论:CVVH模式血液净化联合血必净注射液能增强脓毒症患者的免疫功能,降低脓毒症患者体内的炎症因子水平,提高脓毒症患者生存率,对患者的预后有改善作用。

Objective:To observe the intervention of CVVH model blood purification plus the Xuebijing(血必净)injection on immune function and inflammatory factors in patients with sepsis,and to explore the mechanism of action of blood purification plus the Xuebijing injection on immune status in patients with sepsis.Methods:From January 2018 to December 2019,68 patients were divided into two groups,34 patients in each group.The control group received routine anti-infection,fluid resuscitation,visceral function protection,nutritional support and CVVH blood purification treatment.In the observation group,on the basis of the control group,50 mL of the Xuebijing injection was pumped twice a day for one course of treatment per week.Results:APACHEⅡscore after treatment in two groups were reduced(P<0.05).Compared with the control group,the improvement in the observation group was more significant(P<0.05).After treatment,the levels of CRP,PCT and IL-6 in both groups were significantly lower than before(P<0.05).Compared with the control group,CRP,PCT and IL-6 levels in the observation group were significantly ameliorated(P<0.05).After treatment,the ratio of CD4+and CD4+/CD8+in both groups was increased to different degrees,while the level of CD8+was decreased,with statistically significant differences(P<0.05).Compared with the control group,the improvement of CD4+,CD8+and CD4+/CD8+ratio in the observation group was more significant(P<0.05).Among the patients who completed the study,88.33%(53/60)patients successfully withdrew from the plane.Compared with the control group,the mechanical ventilation time in the observation group was significantly reduced(P<0.05).The 28 d fatality rate in the observation group was significantly different from that in the control group(P<0.05).Conclusion:CVVH model blood purification plus the Xuebijing injection can effectively regulate the immune function of patients with sepsis,reduce the level of inflammatory factors,and improve the prognosis of patients.