摘要
目的 探讨高容量血液滤过对绝经期脓毒症合并多器官功能障碍综合征(MODS)女性患者炎症损伤及预后的影响.方法 选取200 例脓毒症合并MODS绝经期女性患者,随机分为试验组和对照组,各100 例.对照组采用连续性静脉-静脉血液滤过治疗,试验组采用高容量血液滤过治疗.比较两组患者的生命体征、血流动力学指标、炎症因子、序贯器官衰竭评分(SOFA)、急性生理与慢性健康评分量表(APACHE Ⅱ)评分;记录机械通气、ICU住院时间及28d死亡率.结果 治疗后,试验组患者的心率、体温、呼吸频率均低于对照组,平均动脉压(MAP)、心排血指数(CI)、每搏输出量指数(SVI)及外周血管阻力指数(SVRI)均高于对照组(t分别=2.96、4.35、4.37、-4.69、-3.91、-3.74、-2.91,P均＜0.05);试验组患者的白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、高迁移率组蛋白1(HMGB1)及细胞间黏附分子(ICAM1)均低于对照组(t分别=2.90、4.57、2.39、4.95、2.11、3.77,P均＜0.05);试验组患者的SOFA、APACHEⅡ评分均低于对照组(t分别=3.69、2.83,P均＜0.05).试验组患者机械通气及ICU住院时间、28d病死率均低于对照组(t分别=4.04、3.27,χ2=8.87,P均＜0.05).结论 高容量血液滤过可减少绝经期脓毒症合并MODS女性患者炎症水平损伤,并可稳定生命特征,同时降低SOFA评分及APACHEⅡ评分改善预后,减少病死率.
Abstract
Objective To investigate the effect of high-volume hemofiltration on inflammatory injury and prognosis in female patients with menopausal sepsis complicated with multiple organ dysfunction syndrome(MODS).Methods A taotal of 200 menopausal female patients with sepsis complicated with MODS were selected,and divided into experimen-tal group and control group according to random number table method,with 100 cases in each group.The control group re-ceived continuous veno-venous hemofiltration,and the experimental group received high-volume hemofiltration.The vital signs,hemodynamic indexes,inflammatory factors,sequential organ failure assessment(SOFA),acute physiological and chronic health evaluation Ⅱ(APACHE Ⅱ)were compared before and after treatment between the two groups.Mechanical ventilation,length of ICU stay and 28-day mortality were recorded.Results After treatment,the heart rate,body temper-ature and respiration frequency of the experimental group were lower than those of the control group,the mean arterial pressure(MAP),cardiac index(CI),stroke volume index(SVI)and systemic vascular resistance index(SVRI)of the experimental group were higher than those of the control group(t=2.96,4.35,4.37,-4.69,-3.91,-3.74,-2.91,P<0.05).The levels of interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),procalcitonin(PCT),high mobility group box 1(HMGB1)and intercellular adhesion molecule 1(ICAM1)in the experimental group were lower than those in the control group(t=2.90,4.57,2.39,4.95,2.11,3.77,P<0.05).The SOFA score and APACHE Ⅱ score of the experimental group were lower than those of the control group(t=3.69,2.83,P<0.05).The duration of me-chanical ventilation,ICU stay and 28-day mortality in the experimental group were significantly lower than those in the control group(t=4.04,3.27,χ2=8.87,P<0.05).Conclusion High-volume hemo-filtration can reduce inflammatory damage in postmenopausal women with sepsis complicated with MODS,stabilize vital signs,improve SOFA and APACHE Ⅱ scores,and reduce mortality rates.
维普
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