钟俊,杨国辉
ZHONG Jun,YANG Guohui

• 1:贵航贵阳医院重症医学科
• 2:贵州医科大学附院内科ICU

摘要(Abstract)：

目的:探讨连续血液净化(CPB)对脓毒症患者的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及降钙素原(PCT)水平的影响及疗效。方法:75例脓毒症患者,根据治疗方式均分为CPB组(连续血液净化治疗72 h)、IHD组(间断血液透析治疗、8 h/d、共3 d)及对照组(未进行血液净化治疗),分别于治疗前及治疗72 h时检测3组患者血清IL-6、TNF-α及PCT水平,比较治疗72 h时3组患者的机械通气时间、住院时间及住院28 d时的存活率。结果:治疗前,3组患者血清IL-6、TNF-α及PCT水平比较,差异无统计学意义(P> 0. 05);治疗72 h时,CPB组、IHD组血清IL-6、TNF-α及PCT水平低于对照组及同组治疗前(P <0. 05);治疗72 h时,CPB组机械通气时间、住院时间较IHD组及对照组缩短(P <0. 05); CPB组28 d住院存活率明显高于IHD组及对照组(P <0. 05)。结论:CPB能有效提高脓毒症患者的存活率,其机制可能与CPB清除血液炎症介质有关。
Objective: To investigate the clinical efficacy of continuous blood purification in the treatment for sepsis patients and the effect on level of IL-6,TNF-α and PCT. Methods: 75 cases of sepsis patients were divided into continuous hemodialysis group(72 continuous hours),intermittent hemodialysis group(8 hours a day for 3 days),and control groups(no blood purification treatment). For all groups,interleukin-6(IL-6),tumor necrosis factor-α(TNF-α) and procalcitonin(PCT) level were detected before and 72 hr after treatment. Mechanical ventilation time of all patients after 72 hr treatment,hospitalized time and survival rate after 28 days after admission. Results: Before treatment,comparison of serum PCT,IL-6 and TNF-α levels of all patients showed no statistical significance(P > 0. 05); 72 hr after treatment,serum IL-6,TNF-α and PCT level of CPB and IHD group were lower than that of control group and before treatment level(P < 0. 05); mechanical ventilation time and hospitalization time of CPB group were shortened than that of IHD and control group(P < 0. 05);survival rate after 28 days of admission of CPB group was significantly higher than the other two groups(P < 0. 05). Conclusion: Continuous blood purification can effectively improve survival rate of sepsis patients,its mechanism might involving remove inflammatory mediators.

关键词(KeyWords)： 脓毒症;连续血液净化;血液透析;炎性因子;存活率;治疗效果;白细胞介素-6;肿瘤坏死因子-α
sepsis;continuous blood purification;hemodialysis;inflammatory factors;survival rate;curative effects;interleukin 6;tumor necrosis factor α

Abstract:

Keywords:

基金项目(Foundation): 贵州省优秀科技教育人才省长专项基金[黔省专合字(2009)43号]

作者(Author): 钟俊,杨国辉
ZHONG Jun,YANG Guohui

DOI: 10.19367/j.cnki.1000-2707.2018.11.018

参考文献(References)：

• [1]DELLINGER R P,MITCHELL M L,RHODES A,et al.2012 SCCM/ESICM international sepsis definitons conference[J]. Crit Care Med,2013,41(2):580-637.
• [2]SERVILLO G,VARGAS M,PASTORE A,et al. Immunomodulatory effect of continuous venovenous hemofihration during sepsis:preliminary data[J]. Biomed Res Int,2013,2013(4):108951.
• [3]MEHTA R L,BOUCHARD J,SOROKO S B,et al. Sepsis as a cause and consequence of acute kidney injury:Program to Improve Care in Acute Renal Disease[J]. Intensive Care Med,2011,37(2):241-248.
• [4]杨从山,邱海波,刘松桥,等.血管外肺水指数对感染性休克患者预后的评价[J].中华内科杂志,2006,(45):192-195.
• [5]RIMMELT,KELLUM J A. Clinical review:Blood puriication for sepsis[J]. Critical Care,2011,15(1):205.
• [6]林英.同步枸橼酸抗凝与无肝素抗凝在连续性血液净化中的应用及护理[J].大家健康:学术版,2014(21):7-8.
• [7] WARD P A. Immunosuppression in sepsis[J]. JAMA,2011,306(23):2618.
• [8]CHEN X K,LI S W,LIU D W,et al,Effects of central venous pressure on acute kidney injury in septic shock[J]. Zhonghua Yi Xue Za Zhiay,2011,91(19):1323-1327.
• [9]DELLINGER R P,LEVY M M,RHODES A,et al. Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock:2012[J]. Critical Care Medicine,41,580-637.
• [10]尚庆毅.解析白细胞介素-6结合降钙素原与C-反应蛋白在新生儿败血症检测中的临床应用研究[J].中国实用医药,2015,(3):110-111.
• [11]HOLT B G,WHITE J J,KUTHIALA A,et al. Sustained low-efficiency daily dialysis with hemofiltration for acute kidney injury in the presence of sepsis[J]. Clinical Nephrology,2008,69(1):40.
• [12]ANGUS D C. The search for effective therapy for sepsis back to the drawing board[J]. JAMA,2011,306(23):2614-2615.
• [13]何新飙,赵伟,闫素英.持续性肾脏替代治疗在脓毒症诱发多脏器功能失常综合征患者中的应用价值[J].中华急诊医学杂志,2011,20(6):600-603.
• [14]李方.用连续性血液净化疗法与间歇性血液透析疗法治疗ICU急性肾衰竭患者的效果对比[J].当代医药论丛,2015,(1):184-185.
• [15]SERVILLO G,VARGAS M,PASTORE A,et al. Immunomodulatory effect of continuous venovenous hemofiltration during sepsis:preliminary data[J]. Biomed Res Int,2013,2013(7):108951.
• [16]PENG Z Y,CARTER M J,KELLUM J A. Effects of hemoadsorption on cytokine removal and short-term survival in septic rats[J]. Critical Care Medicine,2008,36(5):1573-1577.
• [17]KIMMEL J D,HARBERT E M,PARKER R S. Modeling competitive cytokine adsorption dynamics within hemoadsorption beads used to treat sepsis[J]. Journal of Chromatogr A,2011,1218(44):8013-8020.
• [18]SIVALINGAM M,SUERSH M,FAMNGTON K. Comparison of bytpenatiruer tie pe ptideand NT pro BNP as perdiet or sofsurvivalinpatients on high fluxhem oday sisand hemodi iaf ltartio n[J]. Hemodial Int,2011,15(3):359-365.
• [19]PENUELAS R,FRUTOS-VIVAR F,CRISTINA F C,et al. Characteristics an outcomes of ventilated patients according to time to liberation form mechanical ventilation[J]. Am J Respir Crit Care Med,2011(184):430-437.
• [20]PAGE B,VIEILLARDBARON A,CHERGUI K,et al.Early veno-venous haemodiafiltration for sepsis-related multiple organ failure[J]. Critical Care,2006,10(2):409.

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