血液灌流吸附炎症因子治疗脓毒症的疗效分析

Therapeutic effect of hemoperfusion for absorption of inflammatory cytokines on sepsis

目的 评价血液灌流吸附炎症因子治疗对脓毒症患者的影响。方法 采用前瞻性随机对照研究方法,纳入2019年6月—2021年12月入住我院重症医学科的患者60例,均符合脓毒症的诊断,采用随机数字表法随机分为研究组(30例)和对照组(30例),两组患者均按照脓毒症治疗指南进行常规的治疗,包括液体复苏、机械通气、抗感染以及血管活性药物的应用,对于合并肾衰竭的患者使用肾脏替代治疗(renal eplacement therapy,RRT),并且进行常规的生命体征监测以及抽血进行血清降钙素原(procalcitonin,PCT)以及白细胞介素6(interleukin-6,IL-6)等炎症因子测定。研究组在入组后0 h和24 h分别给予2次血液灌流吸附炎症因子。治疗后24 h、48 h再次记录患者的生命体征及相关理化指标:去甲肾上腺素剂量、氧合指数、PCT、IL-6以及血乳酸。比较两组理化指标的变化以及28天生存率。结果 两组患者的入组时的一般情况无显著差异(P>0.05)。研究组在治疗后24 h及48 h后去甲肾上腺素用量[(0.77±0.48)μg·kg^(-1)·min^(-1)比(0.92±0.62)μg·kg^(-1)·min^(-1),P=0.030]及血乳酸水平[(2.70±1.43)mmol/L比(4.05±2.60)mmol/L,P=0.001]均明显较对照组下降,研究组的氧合指数在治疗24 h后高于对照组[(212±68)mm Hg比(197±42)mm Hg,P=0.042]。研究组的炎症反应相关指标PCT[(17±24)ng/mL比(32±36)ng/mL,P=0.013]及IL-6[299(102,853)pg/mL比937(247,2 230)pg/mL,P=0.026],在治疗48 h后均较对照组显著降低。研究组治疗后的去甲肾上腺素用量、氧合指数、PCT、IL-6以及血乳酸水平都较治疗前有所改善(P<0.05),对照组上述指标在治疗后改善不显著(P>0.05),两组治疗前后氧合指数无明显变化(P>0.05)。两组28天生存率差异无统计学意义(χ^(2)=0.211,P=0.646)。结论 血液灌流吸附炎症因子治疗虽然不能降低脓毒症患者28天病死率,但可以显著改善患者的早期理化指标,为后续治疗争取机会。

Objective To evaluate the effect of hemoperfusion for absorption of inflammatory cytokines on sepsis.Method A prospective randomized controlled study was carried out to collect 60 sepsis patients admitted to the Department of Critical Care Medicine of this hospital from June 2019 to December 2021.They were randomly divided into a study group(30 cases) and a control group(30 cases) by using the random number table method.Both groups of patients received routine treatment according to the guidelines,including fluid resuscitation,mechanical ventilation,antibiotic and vasoactive agents.For the patients with renal failure,renal replacement therapy(RRT) was used.Routine vital sign monitoring and serum procalcitonin(PCT) and interleukin-6(IL-6) determination were recorded.The study group received two times of hemoperfusion to absorb inflammatory cytokines at 0 h and 24 h after enrollment.At 24 h and 48 h after treatment,the vital signs and related physical and chemical indexes of patients were recorded again,including norepinephrine dose,oxygenation index,PCT,IL-6 and blood lactic acid.The changes of physical and chemical indexes and the 28-day survival rate of the two groups were compared.Results There was no difference in the general situation of the two groups when they were enrolled(P<0.05).The dosage of norepinephrine [(0.77±0.48)μg·kg^(-1)·min^(-1) vs.(0.92±0.62) μg·kg^(-1)·min^(-1),P=0.030] and the level of blood lactic acid [(2.70±1.43)mmol/L vs.(4.05±2.60)mmol/L,P=0.001] in the study group were significantly lower than those in the control group 24 h and 48 h after treatment.The oxygenation index in the study group was higher than that of the control group 24 h after treatment(212±68)mm Hg vs.(197±42)mm Hg,P=0.042).The inflammation related indexes PCT [(17±24)ng/mL vs.(32±36)ng/mL,P=0.013] and IL-6 [299(102,853)pg/mL vs.937(247,2 230)pg/mL,P=0.026] in the study group were significantly lower than those in the control group48 h after treatment.The dosage of noradrenaline,oxygenation index,PCT,IL-6 and blood lactate level in the study group after treatment were improved compared with those before treatment(P<0.05),while those in the control group were not significantly improved after treatment(P<0.05),and oxygenation index in the two groups had no significant difference before and after treatment(P<0.05).There was no significant difference in the 28-day survival rate between the two groups(χ^(2)=0.211,P=0.646).Conclusion Although the hemoperfusion for absorption of inflammatory cytokine factors can not reduce the 28-day mortality of sepsis,it can significantly improve the early physical and chemical indicators of patients,and provide opportunities for follow-up treatment.