高容量血液滤过联合血液灌流治疗脓毒症休克合并MODS的临床效果

Clinical effect of high volume hemofiltration combined with hemoperfusion on septic shock complicated by MODS

目的探讨高容量血液滤过(HVHF)联合血液灌流(HP)治疗脓毒症休克合并多器官功能障碍综合征(MODS)的临床效果。方法抽取2019年2月至2021年11月濮阳市人民医院收治的脓毒症休克合并MODS患者142例,按照治疗方案分为HVHF组(HVHF治疗,71例)和HVHF+HP组(HVHF联合HP治疗,71例)。比较两组患者病情、组织灌注指标、细胞因子、ICU时间、机械通气时间和病死率。结果治疗72 h,HVHF+HP组脓毒症相关器官衰竭评估、急性生理与慢性健康状况评分系统Ⅱ评分低于HVHF组(t=6.80、5.96,P均<0.05)。治疗72 h,HVHF+HP组平均动脉压、氧合指数高于HVHF组(t=2.75、3.34,P均<0.05),乳酸水平低于HVHF组(t=2.20,P<0.05)。治疗72 h,HVHF+HP组降钙素原、高迁移率族蛋白B-1、细胞间黏附分子水平低于HVHF组(t=7.95、8.64、16.34,P均<0.05)。HVHF+HP组ICU时间、机械通气时间短于HVHF组(t=3.42、6.64,P均<0.05),病死率(18.31%,13/71)低于HVHF组(33.80%,24/71),P<0.05。结论HVHF联合HP治疗脓毒症休克合并MODS效果确切,相较于单一HVHF更有利于控制病情,改善组织灌注,清除炎症相关细胞因子,可改善患者预后,降低病死率。

Objective To investigate the clinical effects of high volume hemofiltration(HVHF)combined with hemoperfusion(HP)on septic shock complicated by multiple organ dysfunction syndrome(MODS).Methods A total of 142 patients with septic shock complicated by MODS admitted to Puyang People’s Hospital from February 2019 to November 2021 were selected.According to the treatment plans,they were divided into HVHF group(treated by HVHF,71 cases)and HVHF+HP group(treated by HVHF combined with HP,71 cases).The disease condition,tissue perfusion indexes,cytokines,intensive care unit(ICU)time,mechanical ventilation time and case fatality rate were compared between the two groups.Results After 72 hours of treatment,the sepsis-related organ failure assessment score and acute physiology and chronic health status scoring system II score in the HVHF+HP group were lower than those in the HVHF group(t=6.80,5.96;all P<0.05).After 72 hours of treatment,the mean arterial pressure and oxygenation index in the HVHF+HP group were higher than those in the HVHF group(t=2.75,3.34;all P<0.05),and the lactate level in the HVHF+HP group was lower than that in the HVHF group(t=2.20,P<0.05).After 72 hours of treatment,the levels of procalcitonin,high mobility group box protein B-1 and intercellular adhesion molecules in the HVHF+HP group were lower than those in the HVHF group(t=7.95,8.64,16.34;all P<0.05).The ICU time and mechanical ventilation time in the HVHF+HP group were shorter than those in the HVHF group(t=3.42,6.64;all P<0.05).The case fatality rate in the HVHF+HP group(18.31%,13/71)was lower than that in the HVHF group(33.80%,24/71),P<0.05.Conclusions HVHF combined with HP is effective in the treatment of septic shock complicated by MODS;compared with single HVHF,it is more conducive to controlling the disease,improving tissue perfusion,and removing inflammatory-related cytokines,which can improve the prognosis of patients and reduce the case fatality rate.