目的 探讨连续血液净化(continuous blood purification，CBP)对重症脓毒症患者的疗效。方法 选取 2021 年 1 月—2023 年10 月福州市长乐区人民医院收治的90 例重症脓毒症患者纳入研究。以随机数字表法分为对照组与观察组，各 45 例。对照组给予常规治疗，观察组在此基础上予以CBP治疗。对比炎症因子水平、平均动脉压(mean arterial pressure，MAP)、动脉血氧分压(arterial partial pressure of oxygen，PaO2)/吸入氧浓度(inhalation oxygen concentration，FiO2)、血乳酸水平、急性生理与慢性健康评分(acute physiology and chronic health evaluation scoring system，APACHE Ⅱ)、序贯器官衰竭评分(sequential organ failure assessment，SOFA)、免疫指标、并发症发生率及治疗48 h后去甲肾上腺素用量。结果 观察组C-反应蛋白(C-reactiveprotein，CRP)为(36。25±10。12)pg/mL、白细胞介素 6(interleukin 6，IL-6)为(115。22±20。46)ng/L、肿瘤坏死因子-α(tumor necrosis factor-α，TNF-α)为(56。78±12。58)ng/L，低于对照组的(59。42±11。33)pg/mL、(131。72±21。38)ng/L、(65。89±13。63)ng/L(P＜0。05)。观察组血乳酸水平为(2。11±0。17)mmoI/L、APACHE Ⅱ为(17。05±2。09)分、SOFA 为(5。06±0。64)分，低于对照组的(2。53±0。27)mmoI/L、(21。95±2。15)分、(7。32±0。78)分(P＜0。05)。观察组 MAP、PaO2/FiO2、CD4 阳性淋巴细胞(CD4-positive T lymphocytes，CD4+)、CD8 阳性淋巴细胞(CD8-positive T lymphocytes，CD8+)及CD4+/CD8+优于对照组(P＜0。05)。观察组并发症总发生率、治疗 48 h后去甲肾上腺素用量低于对照组(P＜0。05)。结论 CBP治疗重症脓毒症者可抑制炎症反应，改善免疫功能，并可能改善患者结局。
The Therapeutic Effect of Continuous Blood Purification on Severe Sepsis Patients
Objective To investigate the efficacy of continuous blood purification(CBP)for patients with severe sepsis.Methods A total of 90 patients with severe sepsis admitted to Fuzhou Changle District People's Hospital from January 2021 to October 2023 were included in the study.Random number table method was used to divide control group and observation group,45 cases in each group.The control group received routine treatment,while the observation group received CBP treatment on this basis.The levels of inflammatory factors,mean arterial pressure(MAP),arterial partial pressure of oxygen(PaO2)/inhalation oxygen concentration(FiO2),blood lactic acid,acute physiology and chronic health evaluation scoring system(APACHEⅡ),sequential organ failure assessment(SOFA),immune indexes,complication rate and norepinephrine dosage for 48 h were compared.Results The C-reactiveprotein(CRP)of observation group was(36.25±10.12)pg/mL,interleukin 6(IL-6)was(115.22±20.46)ng/L,tumor necrosis factor-α(TNF-α)was(56.78±12.58)ng/L,lower than(59.42±11.33)pg/mL,(131.72±21.38)ng/L,(65.89±13.63)ng/L of control group(P<0.05).The serum lactate level in the observation group was(2.11±0.17)mmoI/L,APACHE Ⅱ was(17.05±2.09)points and SOFA was(5.06±0.64)points,lower than(2.53±0.27)mmoI/L,(21.95±2.15)points,(7.32±0.78)points in control group(P<0.05).MAP,PaO2/FiO2,CD4-positive T lymphocytes(CD4+),CD8-positive T lymphocytes(CD8+)and CD4+/CD8+in observation group were better than those in control group(P<0.05).The total complication rate and the dosage of norepinephrine 48 h after treatment in the observation group were lower than those in the control group(P<0.05).Conclusion In the treatment of severe sepsis,CBP can inhibit inflammatory response,improve immune function and patient outcomes.
severe sepsiscontinuous blood purificationinflammatory factorsimmune functiontherapeutic effectcomplication
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维普
