床旁高流量持续血液净化联合常规药物治疗小儿脓毒症的效果

Effect of bedside high-flow continuous blood purification combined with conventional drug on sepsis in children

目的:探讨床旁高流量持续血液净化(CBP)联合常规药物治疗小儿脓毒症的临床效果,分析其对患儿内皮细胞、单核细胞表面人类白细胞抗原DR位点(HLA-DR)与T淋巴细胞计数的影响。方法:前瞻性抽取郑州大学第一附属医院2018年12月至2020年12月收治的脓毒症患儿72例,经双盲法分为对照组与观察组,每组36例。对照组采用常规药物治疗,观察组在药物治疗的基础上接受床旁高流量CBP治疗。观察两组治疗后内皮细胞功能、HLA-DR、T淋巴细胞计数水平与炎症因子指标变化情况。结果:治疗后,观察组血管性假血友病因子(vWF)、可溶性细胞间粘附分子水平低于对照组,活化蛋白水平高于对照组(P<0.05);治疗后,观察组HLA-DR水平高于对照组(P<0.05),T淋巴细胞亚群优于对照组(P<0.05)。治疗后观察组白细胞介素-6、外周血高迁移率族蛋白B1、白细胞介素-33、肿瘤坏死因子-α水平低于对照组(P<0.05)。结论:脓毒症患儿在药物治疗的基础上,联合采用床旁高流量CBP治疗,可在一定程度上保护内皮细胞功能,调节机体内环境,减轻炎症反应,改善机体免疫功能。

Objective:To investigate the clinical effect of bedside high-flow continuous blood purification(CBP)combined with conventional drug in the treatment of sepsis in children,and to analyze the influence on human leukocyte antigen DR locus(HLA-DR)and T lymphocyte counts on surface of endothelial cells and monocytes.Methods:A total of 72 children with sepsis admitted to the the First Affiliated Hospital of Zhengzhou University from December 2018 to December 2020 were prospectively selected,and they were divided in to a control group and an observation group by double-blind method,with 36 cases in each group.The control group were treated with conventional drugs,and the observation group received bedside high-flow CBP on the basis of conventional drug therapy.The changes of endothelial cell function,HLA-DR,levels of T lymphocyte counts and levels of inflammatory factors in the two groups were observed after treatment.Results:After treatment,the levels of von Willebrand factor and soluble intercellular adhesion molecule-1 in the observation group were lower than those in the control group,while the level of activated protein was higher than those in the control group(P<0.05).After treatment,the HLA-DR level in the observation group was higher than that in the control group(P<0.05),and the T lymphocyte subsets were superior to those in the control group(P<0.05).After treatment,the levels of interleukin-6,blood high mobility group box-1 protein,interleukin-33,and tumor necrosis factor-αin the observation group were lower than those in the control group(P<0.05).Conclusions:Bedside high-flow CBP therapy combined with drug therapy in the treatment of sepsis in children can protect endothelial cell function in a certain degree,regulate the internal environment,reduce the inflammatory response,and ameliorate the immune function.