不同时机采用CBP对严重脓毒症患者的治疗效果评价、各脏器情况及全身炎性反应的影响

The effect of CBP on the treatment of severe sepsis patients,the condition of various organs and the systemic inflammatory response at different timings

目的探讨针对严重脓毒症患者在不同时机采用连续血液净化(CBP)的治疗效果,并分析此种方式对患者各脏器情况及全身炎性反应的影响。方法选择2019年1月-2021年6月于青海红十字医院急诊ICU进行治疗的严重脓毒症患者83例,按照随机数字表法分为A组(n=41)和B组(n=42),所有患者均按照指南内的推荐方案进行治疗,A组开展CBP的时机为患者发病后12-24h,B组则在患者发病后24-48h内开展CBP治疗。随后对比进入ICU时(T1)和开始CBP治疗后1d(T2)及2d(T3)的病情评分,肝、肾及肺功能相关指标,血清炎性因子水平以及治疗2周后患者一般情况及预后情况之间的差异。结果A组患者治疗后T2的APACHEI、MODS评分及SIRS评分显著低于B组(P<0.05),A组患者治疗后T3的三组评分显著低于B组(P<0.05);A组T2及T3时BUN、SCr、ALT及TBi1值显著低于B组(P<0.05);两组患者各时刻PCT、TNF-α、IL-6及IL-8值无显著差异(P>0.05);A组患者治疗过程中去甲肾上腺素平均用量及治疗两周后MODS发生率显著低于B组,而机械通气时间和ICU住院时间显著短于B组(P<0.05),两组患者病死率无显著差异(P>0.05)。结论针对严重脓毒症患者发病后24h内开展CBP治疗能有效改善患者病情,同时减少器官损伤并降低体内炎性反应,且能有效改善患者预后。

Ob jective To investigate the effect of continuous blood purification(CBP)on patients with severe sepsis at different times,and to analyze the effects of this method on various organ conditions and systemic inflammatory response.Methods 83 patients with severe sepsis who were treated in the emergency ICU of Qinghai Red Cross Hospital from January 2019 to June 2021 were divided into groups A(n=41)and B(n=42)according to the random number table method.All patients were treated according to the recommended guidelines in the guidelines.The timing of CBP in group A was 12-24 hours after the onset of the disease,while in group B,CBP was performed within 24-48 hours after the onset of the disease.Then compare the disease scores into the ICU(T1)and 1d(T2)and 2d(T3)after the start of CBP treatment,liver,kidney and lung function related indicators,serum inflammatory factor levels and the general condition and prognosis of patients after 2 weeks of treatment.The difference between the situations.Results A total of 83 patients completed the experiment at the end of the experiment.The APACHE II,MODS score and SIRS score of T2 in group A patients were significantly lower than those in group B(P<0.05).The scores of T3 in group A were significantly lower than those in group B(P<0.05).The BUN,SCr,ALT and TBil values in group A were significantly lower than those in group B(P<0.05).There were no significant diferences in PCT,TNF-α,IL-6 and IL-8 between the two groups(P>0.05).The average dose of norepinephrine during treatment and the incidence of MODS after two weeks of treatment in group A were significantly lower than those in group B,while the duration of mechanical ventilation and ICU stay in group A were significantly shorter than those in group B(P<0.05).There was no significant difference in mortality between the two groups(P>0.05).Conc lus i on For patients with severe sepsis,CBP treatment within 24 hours after onset can effectively improve the patient's condition,reduce organ damage and reduce inflammatory response in the body,and can effectively improve the prognosis of patients.