中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (01): 33-36.doi: 10.3969/j.issn.1671-4091.2013.01.00

• 临床研究 • 上一篇    下一篇

连续性血液净化技术救治重症药物疹患者临床应用研究

杨胜   

  1. 河南省开封市第二人民医院急诊医学科
  • 收稿日期:2012-06-01 修回日期:2012-10-18 出版日期:2013-01-12 发布日期:2013-01-04
  • 通讯作者: 杨胜 E-mail:qxyangsheng@163.com
  • 基金资助:
    开封市科学技术发展基金资助项目(120371)

Clinical Application of Continuous Blood Purification in Treatment of Severe Drug Eruption

  • Received:2012-06-01 Revised:2012-10-18 Online:2013-01-12 Published:2013-01-04

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摘要： 目的：研究应用连续性血液净化在救治重症药疹患者的临床疗效。方法：66例重症药疹患者随机分两组：常规治疗组采用常规治疗，血液净化组在常规治疗基础上早期行连续性血液净化治疗。在治疗前及治疗后第8、15天，两组分别进行APACHEⅡ评分，检测血清肿瘤坏死因子a(TNF-a)、白细胞介素6（IL-6）及超敏C反应蛋白（hs-CRP）水平变化，行对比分析；在治疗后第8天观察全身皮疹状况改善程度进行比较，并对患者并发症及28天转归情况进行比较。结果：治疗第8天，全身皮疹状况改善程度，常规治疗组总效有效率为54.54％，血液净化组为87.87％，两组间差异有显著统计学意义(χ2=31.29,P<0.01)；APACHEⅡ评分在治疗后8、15天两组间差异显著，均有统计学意义（P<0.05）；检测血浆肿瘤坏死因子a(TNF-a)、白细胞介素6（IL-6）、超敏C反应蛋白（hs-CRP）水平，血液净化组与常规治疗组在治疗第8天比较差异均有统计学意义(P＜0.01）；并发症及28天转归比较：常规组并发脓毒症发生率78.8％，净化组36.4%，(χ2= 12.16，P＜0．01）；常规组并发多器官功能障碍综合征（MODS）为57.6％，血液净化组24.2％，两组间差异显著有统计学意义(χ2=7.58，P＜0．01）；常规组病死率39.4％,净化组病死率12.2％，差异有统计学意义(χ2=6.42，P＜0．05)；结论 连续性血液净化治疗重症药疹，临床疗效可靠，显著改善患者预后，值得推广应用。

关键词: 重症药疹, 连续性血液净化, 脓毒症, 多器官功能障碍综合征, 预后

Abstract: [Abstract] Objective To study the clinical application of continuous blood purification (hemoperfusion and hemofiltration) in patients with severe drug eruption. Methods 66 patients with severe drug eruption were randomly divided into two groups, general treatment group （n=33） and blood purification group（n=33）. General treatment group was treated by normal treatment, while the blood purification group treated by early continuous blood purification treatment on the basis of normal treatment. Acute physiology and chronic health evaluationⅡ（APACHE II ）score of the two groups recorded on the first day before treatment and post-treatment 8th,15th day, and blood samples collected on the first day and the 8th,15th day after treatment for plasma contents of TNF-a,IL一6 ,and the plasma levels of hs-CRP were compared and analyzed. Observe and compare the improvement of the whole body skin rash condition between the two groups on the 8th day after treatment, and compare the complications and prognosis on the 28th day after treatment. Results After 8days of treatment, drug eruption were improved remarkably, the total efficiency rate of blood purification group was 87.87％,while the general treatment group was 54.54％, the difference was statistically(χ2=31.29,P<0．01). and APAPHEⅡ score after 8days and 15days were all decreased gradually, while the differences between two groups have obvious statistical significance (P<0.05); 8days after treatment ,blood purification group for plasma contents of TNF-a,IL一6 , and the plasma levels of hs-CRP determined were decreased significantly than that general treatment group（P<0．01）;the prognosis within 28 day, the occurrence of septic （χ2=12.16，P<0．01）and MODS（χ2= 7.58，P<0．01) ,and the morbidity of detection decreased obviously (χ2= 6.42，P﹤0．05) in the blood purification group compared with the general treatment group. Conclusion Patients with Severe Drug Eruption received treatment of continuous blood purification have better clinical effective, treatment of continuous blood purification can improve the prognosis of the patients .It is worthy of promotion.

Key words: Severe Drug Eruption, continuous blood purification, Sepsis, multiple organ dysfunction syndrome, Prognosis

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