早期连续血液滤过对重症脓毒症患者影响的临床研究

摘要

目的 评价早期连续应用血液滤过技术治疗重症脓毒症患者的临床疗效.方法 将符合纳入标准的63例患者随机分为血液滤过组32例和基础治疗组31例,血液滤过组在基础治疗组的基础上加用24 h连续血液滤过治疗技术,分析2组治疗前、治疗后72 h炎症指标变化[血清降钙素原(PCT)、C-反应蛋白(CRP)、IL-6、IL-10]、血流动力学变化(心率、平均动脉压、氧合指数)、APACHE Ⅱ评分变化.结果 2组治疗后72 h炎症指标除IL-10变化差异无统计学意义(P>0.05),其他指标(PCT、CRP、IL-6)均较治疗前有明显改善,差异有统计学意义(P<0.05).2组比较血液滤过组PCT、CRP、IL-6的降低程度远高于基础治疗组,差异有统计学意义(P<0.05);血流动力学变化(心率、平均动脉压、氧合指数)均较治疗前改善(P<0.05),其中氧合指数组间比较差异有统计学意义(P<0.05),血液滤过组明显优于基础治疗组;2组APACHE Ⅱ评分组内前后比较差异有统计学意义(P<0.05),组间比较血液滤过组评分明显低于基础治疗组(P<0.05).结论 早期采用连续性血液滤过的疗法治疗人群重症脓毒症,能更有效清除炎症因子,改善机体的氧合功能,维持机体血流动力学稳定.%Objective To evaluate the clinical curative effects of early continuous hemodilution on severe sepsis. Methods Sixty-three patients with severe sepsis were randomly divided into early hemofiltration group (n=32) and basal therapy group (n =31). The patients in basal therapy group were treated by conventional basic treatment,however,the patients in early hemofiltration treatment group,on the basis of basal therapy group,were treated by 24-hour continuous hemofiltration.The changes of PCT,CRP,IL-6,IL-10,hemodynamics indexes including heart rate, mean arterial pressure, oxygenation index and APACHE Ⅱ score before treatment and at 72 hours after treatment were observed and compared between two groups.Results After treatment there were no significant differences in inflammatory indexes except for IL-10 at 72 hours after treatment between two groups (P >0.05),however,the other indexes including PCT, CRP and IL-6 were significantly improved in both groups,as compared with those before treatment(P<0.05). The levels of PCT,CRP and IL-6 in early hemofiltration group were significantly lower than those in basal therapy group (P<0.05).Moreover the changes of hemodynamics indexes including heart rate,mean arterial pressure and oxygenation index were significantly improved in both groups,as compared with those before treatment (P<0.05),in which, there was significant difference in oxygenation index between two groups (P<0.05),which in early hemofiltration group was superior to that in basic treatment group.In addition the APACHE Ⅱ scores in early hematofilter group were significantly lower than those in basic treatment group (P<0.05). Conclusion The early continuous hemofiltration in treatment of severe sepsis can effectively remove inflammatory factors, improve the oxygenation function and stabilize the hemodynamics of the body.