血液净化对烧伤脓毒症患者血清炎性细胞因子的影响

摘要

Objective To investigate the influence of blood purification on inflammatory cytokines of patients with burn sepsis.Methods 28 patients in our hospital from January 2013 to December 2014 were selected and divided into control group and observation group.Control group was given common burn treatment.The observation group was given blood purification based on control group.WBC,Lac,Na+,PCT,PaO2/FiO2,BUN,Scr,TNF-α,IL-6 and IL-8 before treatment,24h and 48h after treatment were observed.Results Compared with 1d before treatment,oxygenation index of observation group 24h and 48h after treatment were higher than tha of control group (P＜0.05).The oxygenation index of observation group was better than that of control group at same time point (P＜0.05).Lac had no obvious changes between two groups (P＞0.05).Lac declined 24h and 48h after treatment (P＜0.05).Lac of two groups at same time point had statistic significance (P＜0.05).Scr declined after treatment of observation group.Scr of observation group declined more obviusely than that of control group at one time point (P＜0.05 or P＜0.001).BUN of observation group was better than that of control group (P＜0.05).Scr and BUN of two groups at one time point had statistic significance (P＜0.05).after treatment,WBC declined (P＜0.05).WBC at one time point of observation group was better than that of control group (P＜0.05).Na+ of observation group declined after treatment (P＜0.05).The difference of control group between groups had no statistic significance (P＞0.05).After treatment,Na+ of observation group declined more obviously at each time point (P＜0.05).PCT of observation group was lower than that of control group at same time point (P＜0.001).TNF-a,IL-6 and IL-8 of control group after treatment had no obvious difference (P＞ 0.05).24h and 48h after treatment,TNF-a,IL-6 and IL-8 of observation group were better than that of control group (P＜0.05).TNF-a,IL-6 and IL-8 of two groups after treatment had statistic significance (P＜0.05).Conclusion Blood purification based on common burn treatment can effectively clean inflammatory cytokines and improve organ function of patients with burn sepsis.%目的 探讨血液净化对烧伤脓毒症患者血清炎性细胞因子的影响.方法 选取2013年1月～2014年12月入我院经烧伤科收治符合研究标准的烧伤患者28例.根据烧伤脓毒症患者的入院时间顺序,将患者平均分为对照组与观察组.对照组进行常规烧伤治疗,观察组患者在对照组治疗基础上进行血液净化治疗.比较两组患者治疗前1d、治疗后24、48h血液中WBC、Lac、Na+、PCT、PaO2/FiO2、BUN、Scr及炎症因子TNF-α、IL-6、IL-8水平变化.结果 与治疗前1d相比,治疗后24、48h观察组氧合指数较对照组均明显升高(P＜0.05),观察组在同一治疗时间点中氧合指数水平优于对照组(P＜0.05);与治疗前相比,对照组治疗后24、48h Lac水平无明显变化(P＞0.05);观察组在治疗后24、48h的Lac水平呈下降趋势(P＜0.05),两组间同时间点Lac水平比较具有统计学差异(P＜0.05);观察组患者在治疗后Scr浓度水平均呈现下降趋势(P＜0.05),同一时间点观察组Scr水平较对照组下降幅度更显著(P＜0.05或P＜0.001);观察组治疗后24、48h的BUN水平显著优于对照组(P＜0.05),两组间同一治疗时间点Scr、BUN水平具有差异性(P＜0.05);治疗后WBC计数呈下降趋势,组内比较差异具有统计学意义(P＜0.05);观察组治疗后同一治疗时间点WBC计数优于对照组(P＜0.05);观察组患者治疗后各治疗时间点较治疗前Na+浓度均有下降(P＜0.05);对照组治疗后组内比较均无统计学意义(P＞0.05);两组间治疗后各治疗时间点比较观察组血清Na+浓度下降幅度更显著(P＜0.05);观察组患者在治疗后PCT表达水平呈下降的趋势(P＜0.05);同一时间点观察组PCT表达水平低于对照组(P＜0.001);对照组治疗后TNF-a、IL-6与IL-8的表达水平无明显差异(P＞0.05);观察组治疗后24h、48h的TNF-a、IL-6与IL-8的表达水平均较对照组佳(P＜0.05);两组间治疗后各时间点TNF-a、IL-6与IL-8的表达水平具有差异(P＜0.05).结论 烧伤脓毒症患者在常规治疗的基础上进行血液净化治疗,可有效清除患者体内炎症介质因子,改善烧伤脓毒症患者的脏器功能,维持机体内环境平衡,是治疗烧伤脓毒症的一种有效方法,可在临床推广运用.