连续性肾脏替代治疗联合血液灌流对脓毒症患者临床疗效的影响

Effect of continuous renal replacement therapy combined with hemoperfusion on the clinical efficacy of patients with severe sepsis

目的观察连续性肾脏替代治疗(CRRT)联合血液灌流(HP)对脓毒症患者临床疗效的影响。方法选择2019年1月至2020年6月郑州市第六人民医院收治的62例脓毒症患者作为研究对象。将患者按治疗方法不同分为常规治疗对照组(32例)和CRRT+HP治疗组(30例)。常规治疗对照组给予充足的氧合、抗感染、营养支持、容量控制和器官功能支持治疗;CRRT+HP治疗组在常规治疗基础上给予CRRT联合HP治疗。比较两组患者生命体征、炎症因子〔C-反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)、白细胞计数(WBC)〕、生化指标〔血肌酐(SCr)、乳酸脱氢酶(LDH)、血小板计数(PLT)、血乳酸(Lac)〕等的差异,并观察28 d病死率的变化及不良反应发生情况。结果与治疗前比较,两组治疗后体温、呼吸频率、心率、CRP、PCT、IL-6、WBC、SCr、LDH、Lac均明显降低,收缩压及PLT均明显升高(均P<0.05)。与常规治疗对照组比较,CRRT+HP治疗组治疗后体温、呼吸频率、心率、CRP、PCT、IL-6、WBC、SCr、LDH、Lac的下降幅度更大〔体温下降率:(2.25±1.15)%比(1.41±1.17)%,呼吸频率下降率:(21.54±11.76)%比(14.97±9.40)%,心率下降率:(13.57±8.03)%比(6.63±3.71)%,CRP下降率:(42.95±9.40)%比(34.58±16.10)%,PCT下降率:(50.49±19.41)%比(29.03±11.43)%,IL-6下降率:(45.22±12.68)%比(34.30±14.12)%,WBC下降率:(30.01±20.94)%比(17.35±15.55)%,SCr下降率(49.72±16.78)%比(32.41±21.11)%,LDH下降率:(37.04±18.49)%比(26.82±12.21)%,Lac下降率(37.76±17.91)%比(29.15±9.81)%,均P<0.05〕,收缩压升高幅度更大〔(-10.47±8.96)%比(-4.38±3.81)%,P<0.05〕,病死率明显降低〔3.33%(1/30)比9.38%(3/32),P<0.05〕。CRRT+HP治疗组和常规治疗对照组PLT变化率比较差异无统计学意义〔(-15.56±35.69)%比(-11.46±14.47)%,P>0.05〕。在CRRT+HP治疗过程中,有3例患者出现深静脉置管处渗血,经压迫后渗血停止,未发生过敏、心律失常、严重低血压等不良反应。结论CRRT联合HP较单纯内科治疗能有效清除炎症介质,减轻全身炎症反应综合征(SIRS)导致的多器官功能损伤,降低Lac水平,平衡机体内环境,改善患者生命体征,且CRRT联合HP治疗过程中无明显不良反应。

Objective To observe the effect of continuous renal replacement therapy(CRRT)combined with hemoperfusion(HP)on the clinical efficacy of sepsis patients.Methods Sixty-two patients with sepsis admitted to the Sixth People's Hospital of Zhengzhou City from January 2019 to June 2020 were selected as the study objects.The patients were divided into conventional treatment control group(32 cases)and CRRT+HP treatment group(30 cases)according to different treatment methods.The conventional treatment control group was given adequate oxygenation,anti-infection,nutritional support,volume control and organ function support treatment;CRRT+HP treatment group was CRRT combined with HP treatment on the basis of conventional treatment.The difference of vital signs,inflammatory factors[C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6),white blood cell count(WBC)],biochemical indicators[serum creatinine(SCr),lactate dehydrogenase(LDH),platelet count(PLT),blood lactic acid(Lac)]and so on were compared between the two groups,the change of 28-day mortality and the occurrence of adverse reactions were observed.Results Compared with before treatment,the body temperature,respiratory rate,heart rate,CRP,PCT,IL-6,WBC,SCr,LDH and Lac after treatment in two groups were significantly decreased,systolic blood pressure and PLT were significantly increased(all P<0.05).Compared with conventional treatment control group,the body temperature,respiratory rate,heart rate,CRP,PCT,IL-6,WBC,SCr,LDH and Lac decreased much more after treatment in CRRT+HP treatment group[decrease rate of body temperature:(2.25±1.15)%vs.(1.41±1.17)%,decrease rate of respiratory rate:(21.54±11.76)%vs.(14.97±9.40)%,decrease rate of heart rate:(13.57±8.03)%vs.(6.63±3.71)%,decrease rate of CRP:(42.95±9.40)%vs.(34.58±16.10)%,decrease rate of PCT:(50.49±19.41)%vs.(29.03±11.43)%,decrease rate of IL-6:(45.22±12.68)%vs.(34.30±14.12)%,decrease rate of WBC:(30.01±20.94)%vs.(17.35±15.55)%,decrease rate of SCr:(49.72±16.78)%vs.(32.41±21.11)%,decrease rate of LDH:(37.04±18.49)%vs.(26.82±12.21)%,decrease rate of Lac:(37.76±17.91)%vs.(29.15±9.81)%,all P<0.05],systolic blood pressure increased much more[(-10.47±8.96)%vs.(-4.38±3.81)%,P<0.05],the mortality of CRRT+HP treatment group was significantly reduced[3.33%(1/30)vs.9.38%(3/32),P<0.05].There was no significant difference in PLT change rate between CRRT+HP treatment group and conventional treatment control group[(-15.56±35.69)%vs.(-11.46±14.47)%,P>0.05].In the course of CRRT+HP treatment,3 patients with deep vein catheterization bleeding,stopped after compression,and no adverse reactions such as allergy,arrhythmia,and severe hypotension occurred.Conclusion Compared with the simple medical treatment,CRRT combined with HP can effectively remove inflammatory mediators,alleviated multiple organ function injury caused by systemic inflammatory response syndrome(SIRS)and reduce the level of Lac,balance the internal environment,and improve the vital signs of patients,and there was no obvious adverse reaction in the treatment of CRRT combined with HP.