血液灌流HA380联合静脉-静脉血液透析滤过在脓毒症中的临床应用

Clinical application of hemoperfusion HA380 combined with veno venous hemodiafiltration in sepsis

目的探讨血液灌流HA380联合静脉-静脉血液透析滤过(CVVHDF)治疗脓毒症的临床效果。方法分析2021年7月至2022年4月就诊武汉大学中南医院重症医学科的60例脓毒症患者的临床资料,根据患者是否同意HA380治疗分为试验组和对照组,各30例。试验组在CVVHDF基础上联合HA380治疗,对照组接受CVVHDF治疗,观察两组患者炎症指标白细胞(WBC)、降钙素原(PCT)、白细胞介素-6(IL-6)、肝素结合蛋白(HBP)、C反应蛋白(CRP)水平及去甲肾上素(NE)使用剂量变化,同时记录治疗0、24、48 h的急性生理学及慢性健康状况评分系统(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分变化及7 d和28 d临床结局。结果试验组血液灌流后炎症指标逐渐下降且第2次血液灌流后IL-6(t=13.424,P<0.05)、第3次血液灌流后PCT/IL-6/CRP(t=2.423、6.529、2.234,P<0.05)、第4次血液灌流后PCT/IL-6/HBP/CRP(t=2.861、12.534、3.387、7.270,P<0.05)的改善情况均优于对照组(P<0.05)。试验组血液灌流后NE使用剂量明显少于前一次,且第2、3、4次血液灌流后NE使用剂量均显著少于对照组(t=2.186、5.001、3.349,P<0.05)。患者血液灌流48 h的APACHEⅡ评分、SOFA评分较血液灌流24 h比较均改善且优于对照组(t=3.556、4.086,P<0.05)。试验组机械通气时间、住院重症监护室(ICU)费用及7 d死亡率均较对照组显著改善(t=3.610、9.066、4.811,P<0.05),但ICU治疗时间及28 d死亡率差异无统计学意义。结论血液灌流HA380联合CVVHDF治疗脓毒症能够提高治疗临床治疗效果,减轻患者炎性反应,促进患者的早日康复。

Objective To investigate the clinical effect of hemoperfusion HA380 combined with veno venous hemodiafiltration(CVVHDF)in the treatment of sepsis.Methods Retrospective analysis was used to analyze the clinical data of 60 patients with sepsis who visited the Department of Severe Medicine of Zhongnan Hospital of Wuhan University from July 2021 to April 2022.According to whether the patients agreed to HA380 treatment,they were divided into test group and control group with 30 patients in each group.The test group was treated with HA380 on the basis of CVVHDF,and the control group was treated with CVVHDF.The levels of inflammatory indicators such as white blood cells(WBC),procalcitonin(PCT),interleukin-6(IL-6),heparin binding protein(HBP),C-reactive protein(CRP)and the dose change of norepinephrine(NE)were observed in the two groups.At the same time,the acute physiology and chronic health scoring system(APACHEⅡ)scores,sequential organ failure(SOFA)score changes and clinical outcomes were recorded at 7 and 28 days.Results The inflammatory indexes in the test group decreased gradually after hemoperfusion,and the improvement of IL-6 after the second hemoperfusion(t=13.424,P<0.05),PCT/IL-6/CRP after the third hemoperfusion(t=2.423,6.529,2.234,P<0.05),and PCT/IL-6/HBP/CRP after the fourth hemoperfusion(t=2.861,12.534,3.387,7.270,P<0.05)were better than those in the control group(P<0.05).The dose of NE in the test group after hemoperfusion was significantly reduced as compared with the previous one,and the dose of NE in the second,third and fourth hemoperfusion was significantly lower than that in the control group(t=2.186,5.001,3.349,P<0.05).The APACHEⅡscore and SOFA score at 48th h of hemoperfusion were improved and better than those at 24th h of hemoperfusion in the control group(t=3.556,4.086,P<0.05).The time of mechanical ventilation,the cost of hospitalization in intensive care unit(ICU)and the 7-day mortality rate in the test group were significantly improved as compared with those in the control group(t=3.610,9.066,4.811,P<0.05),but there was no significant difference in the time spent in ICU and the 28 day mortality rate.Conclusion Hemoperfusion HA380 combined with CVVHDF in the treatment of sepsis can improve the clinical therapeutic effect,reduce the inflammatory reaction of patients,and promote the early recovery of patients.It is worth being widely used in clinical practice.