血液灌流在心脏术后严重脓毒症中的应用

Application of hemodialysis in severe sepsis after cardiac surgery

目的探讨血液灌流在心脏术后严重脓毒症中的应用。方法选取2020年1月至2021年7月于高州市人民医院进行治疗的60例心脏术后并发严重脓毒症患者作为研究对象,依据随机数字表法分为常规组(n=30)和研究组(n=30)。常规组在常规治疗的基础上连续静脉-静脉血液滤过治疗,研究组在常规治疗的基础上进行血液灌流治疗。比较两种不同治疗方法对患者血清炎症介质水平、舌下微循环指标、序贯器官功能衰竭评估(SOFA)评分、急性生理学与慢性健康状况评分(APACHEⅡ)的影响。结果治疗前,两组患者的血清炎症介质水平、舌下微循环指标、APACHEⅡ分值及SOFA分值比较,差异无统计学意义(P>0.05)。治疗后,两组患者的降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及C反应蛋白(CRP)水平低于本组治疗前,且研究组的PCT、TNF-α、IL-6及CRP水平低于常规组,差异有统计学意义(P<0.05);两组患者治疗后的微血管流动指数(MFI)、灌注血管比例(PPV)水平高于本组治疗前,且研究组治疗后的MFI、PPV水平高于常规组,差异有统计学意义(P<0.05);两组患者治疗后的SOFA评分、APACHEⅡ评分低于本组治疗前,且研究组治疗后的SOFA评分、APACHEⅡ评分低于常规组,差异有统计学意义(P<0.05)。结论对心脏术后严重脓毒症患者应用血液灌流治疗能够有效降低患者机体内的炎症反应,促进患者机体微循环功能的恢复,并降低对器官造成的损伤,有效改善患者预后。

Objective To investigate the application of hemodialysis in severe sepsis after cardiac surgery.Methods A total of 60 patients with severe sepsis after cardiac surgery who were treated in Gaozhou People's Hospital from January 2020 to July 2021 were selected as the research objects,and they were divided into the routine group(n=30)and the study group(n=30)according to the random number table method.The routine group was treated with continuous veno-venous hemofiltration on the basis of routine treatment,while the study group was treated with hemodialysis on the basis of routine treatment.The influence of two different treatment methods on serum inflammatory mediator level,sublingual microcirculation index,sequential organ failure assessment(SOFA)score,and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score were compared.Results There were no significant differences before treatment between the two groups in the serum inflammatory mediator level,sublingual microcirculation index,APACHEⅡscore and SOFA score(P>0.05).The levels of procalcitonin(PCT),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP)of patients in the two groups after treatment were lower than those before treatment,and the levels of PCT,TNF-α,IL-6 and CRP in the study group after treatment were lower than those in the routine group,the differences were statistically significant(P<0.05).The levels of microvascular flow index(MFI)and proportion of perfused vessels(PPV)of the two groups after treatment were higher than those before treatment,and the levels of MFI and PPV of the study group after treatment were higher than those of the routine group,the differences were statistically significant(P<0.05).The scores of SOFA and APACHEⅡof the two groups after treatment were lower than those before treatment,and the scores of SOFA and APACHEⅡof the study group after treatment were lower than those of the routine group,the differences were statistically significant(P<0.05).Conclusion Hemodialysis treatment for patients with severe sepsis after cardiac surgery can effectively reduce the inflammatory reaction in the body,promote the recovery of microcirculation function,reduce the degree of damage to organs,and effectively improve the prognosis of patients.