中国血液净化

›› 2015, Vol. 14 ›› Issue (02): 0-0.

• 临床研究 •    下一篇

配对血浆滤过吸附在严重脓毒症中的应用研究

赵 黎1,陈华茜2,阮华玲3   

  1. 1. 湖北医药学院附属东风医院肾病内科
    2. 十堰 郧阳医学院附属东风医院 1肾病内科，2内分泌科
    3. 湖北医药学院附属东风医院内分泌科
  • 收稿日期:2014-06-19 修回日期:2014-10-16 出版日期:2015-02-12 发布日期:2015-02-12
  • 通讯作者: 赵 黎 E-mail:sunny2000954@163.com

Application of coupled plasma filtration adsorption in patients with severe sepsis

  • Received:2014-06-19 Revised:2014-10-16 Online:2015-02-12 Published:2015-02-12

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摘要： 【摘要】目的：通过比较配对血浆滤过吸附（CPFA）和高容量血液滤过（HVHF）对严重脓毒症的疗效，探讨配对血浆滤过吸附治疗的优势。方法：选择35例严重脓毒症患者，随机分为CPFA组（18例）和HVHF组（17例），在常规治疗的基础上分别联用CPFA治疗和HVHF治疗。观察两组治疗前和治疗10小时后体温、心率、平均动脉压、多巴胺用量、氧合指数、血常规、肝肾功电解质、血乳酸、免疫球蛋白、补体、APACHEⅡ评分、TNF-α、IL-10、高迁移率簇蛋白-1（HMGB-1）、CRP的变化，同时评估两种治疗的安全性。结果：两种治疗均能降低体温、心率、血肌酐、尿素氮、血乳酸、多巴胺用量、APACHEⅡ评分，升高平均动脉压、氧合指数，维持水、电解质、酸碱平衡，两种治疗差异无统计学意义(P>0.05)。两种治疗对白细胞、血红蛋白、血小板、谷丙转氨酶、谷草转氨酶、胆红素、血清白蛋白、免疫球蛋白、补体均无明显影响(P>0.05)。两种治疗均能降低患者的TNF-α、IL-10、HMGB-1、CRP (P<0.05)，但CPFA治疗后上述指标下降幅度大于HVHF组(P<0.05)。两种治疗安全，患者未出现出血、栓塞、过敏等并发症。结论：CPFA和HVHF均能安全、有效地调节严重脓毒症患者的内环境，但在降低炎症因子方面，CPFA更具优势。

关键词: 【关键词】严重脓毒症, 配对血浆滤过吸附, 高容量血液滤过, 炎症因子, 【Key words】severe sepsis , coupled plasma filtration adsorption , high volume hemofiltration , inflammation factors

Abstract: 【Abstract】 Objective：By comparing the treatment effectiveness of coupled plasma filtration adsorption (CPFA) and high volume hemofiltration(HVHF) in patients with severe sepsis，to investigate the advantages of CPFA．Methodology：Thirty-five patients with severe sepsis were randomly divided into CPFA group(n=18) and HVHF group(n=17)．The patients received CPFA or HVHF on the basis of routine therapy．Changes of the body temperature，heart rate(HR)，mean arterial pressure(MAP)，the dose of dopamine，the oxygenation index(PaO2/FiO2)，blood routine，biochemical parameters of liver and kidney function，the electrolytes，blood lactic acid，immune globulin，complement，APACHEⅡ score，TNF-α，IL-10，HMGB-1，CRP were compared between the 2 groups before and after the treatment for 10 hours．The safety of the two kinds of treatment were simultaneously evaluated．Results：After the two therapies，the body temperature，HR，serum creatinine(Scr)，BUN，blood lactic acid，the dose of dopamine，APACHEⅡ score were all significantly decreasad，the MAP and PaO2/FiO2 were significantly increased，electrolytes and acid-base balance were well maintained，there were no statistical differences between the 2 groups(P>0.05)．After the two kinds of treatment，no visible influences were found in the 2 groups in the levels of white blood cell count，hemoglobin count，platelet count，alanine transaminase，aspartate aminotransferase，bilirubin，serum albumin，immune globulin，complement(P>0.05)．After the two therapies，the levels of TNF-α，IL-10，HMGB-1，CRP were all significantly decreased(P<0.05)，however，these changes were more evident in CPFA group than in HVHF group(P<0.05)．The two therapies were safe，and no therapy related adverse reactions such as haemorrhage，hypersensitiveness or embolism were noted during the two therapies．Conclusion：Although both CPFA and HVHF can safely and effectively adjust the internal environment of patients with severe sepsis，CPFA has better abilities in lowering levels of inflammation factors．