Objective To assess the clinical efficacy of continuous blood purification (CBP) in treatment of severe pneumonia patients complicated with respiratory failure.Methods Eighty six severe pneumonia patients complicated with respiratory failure admitted in ICU from March 2014 to October 2016.The patients were randomly assigned in study group and control group with 43 cases in each group.All patients received routine treatment,including oxygen inhalation,anti-infection,assisted ventilation and spasmolysis,the study group was given CBP additionaly.The serum TNF-α,IL-6,IL-8 and CRP levels were measured,arterial blood gas indexes were examined and acute physiologic and chronic health evaluation Ⅱ (APACHE Ⅱ) scores were evaluated before and d3,d7 after treatment.Results Serum levels of TNF-α,IL-6,IL-8 and CRP at d3 and d7 after treatment in the study group significantly lower than those before treatment,and also lower than those in the control group after treatment (P＜0.05 or 0.01).The PaO2,PaO2/FiO2 of the study group were significantly higher,and PaCO2 was significantly lower than those of the control group (P＜0.05 or 0.01).The APACHE Ⅱ scores of the study group at d7 after treatment were significantly lower than those of control group (P.＜0.05).Conclusion Continuous blood purification in addition to routine treatment can decrease serum levels of proinflammatory cytokins,improve pulmonary function and reduce APACHE Ⅱ scores,resulting in better clinical efficacy for severe pneumonia patients complicated with respiratory failure.%目的 探讨连续性血液净化(CBP)治疗重症肺炎合并呼吸衰竭的临床疗效及对炎性因子的影响.方法 将86例重症肺炎合并呼吸衰竭患者按随机数字表法分为对照组和研究组,每组43例.两组患者均采用吸氧、抗感染、辅助通气、解痉等常规治疗,研究组在此基础上予以CBP治疗.两组患者治疗前及治疗3、7d后分别测定外周血相关炎性因子水平和动脉血气指标、APACHEIⅡ评分,判定临床疗效.结果 治疗3、7d后,研究组患者TNF-α、IL-6、IL-8、C反应蛋白(CRP)水平较治疗前均明显降低,且均显著低于对照组,差异均有统计学意义(P＜0.05或0.01).治疗3、7d后,研究组Pa02、氧合指数(PaO2/FiO2)较对照组显著升高,PaCO2较对照组显著降低,差异均有统计学意义(P＜0.05或0.01).治疗7d后,研究组APACHE Ⅱ评分明显低于对照组,差异均有统计学意义(均P＜0.05).结论 重症肺炎患者在常规治疗基础上联合使用CBP治疗可明显降低患者体内的炎性因子水平,明显改善肺部氧合功能,降低APACHEⅡ评分,改善患者预后.
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