2019 年第 10 期 第 14 卷

连续低效每日血液透析滤过联合血液灌流对严重脓毒症患者炎性应激和肾功能及微循环的影响

Effect of sustained low efficiency daily hemodiafiltration combined with hemoperfusion on inflammatory stress, renal function and microcirculation in patients with severe sepsis

作者：邹蕾黄志远高燕崔岩

英文作者：

单位：110016沈阳，中国人民解放军北部战区总医院急诊医学部

英文单位：

关键词：严重脓毒症；连续低效每日透析滤过；血液灌流；炎症反应

英文关键词：

• 摘要：

• 【摘要】目的    探讨连续低效每日血液透析滤过(SLEDD-f)联合血液灌流对严重脓毒症患者炎性应激、肾功能及微循环的影响。方法    选取2015年1月至2017年10月在中国人民解放军北部战区总医院就诊的严重脓毒症患者86例作为研究对象，采用随机数字表法将患者分为观察组和对照组，各43例。在常规治疗基础上，对照组采用SLEDD-f的治疗方案，观察组采用SLEDD-f联合血液灌流的治疗方案。比较2组患者治疗前后（治疗第7天）的生命体征、白细胞计数水平、血清中炎症因子［C反应蛋白（CRP）、降钙素原、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)］和肾功能指标（血肌酐、血尿素氮）、舌下微循环指标［灌注血管比例(PPV)、微血管流动指数(MFI)］、生活质量评分及预后［序贯器官功能衰竭评估(SOFA)评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分］。结果    治疗前，2组患者所有观察指标比较差异均无统计学意义（均P＞0.05）。治疗后，观察组体温、白细胞计数水平低于对照组，平均动脉压高于对照组，CRP、TNF-α、IL-6水平低于对照组，血尿素氮、血肌酐低于对照组，PPV及MFI高于对照组，躯体功能、心理功能评分高于对照组，APACHEⅡ评分低于对照组［（36.7±0.6）℃比（37.6±0.6）℃、（7.7±2.0）×109/L比（11.4±2.8）×109/L、（112±11）mmHg(1 mmHg=0.133 kPa)比（98±10）mmHg、（10±5）mg/L比（15±6）mg/L、（31±12）ng/L比（37±13）ng/L、（25.5±2.8）ng/L比（39.7±3.2）ng/L、（6.4±1.1）mmol/L比（7.8±1.0）mmol/L、（60±5）μmol/L比（65±6）μmol/L、（44.1±3.6）%比（38.2±2.8）%、（2.7±0.4）比（2.2±1.2）、（68±8）分比（64±8）分、（65±7）分比（57±6）分、（10±3）分比（15±3）分］，差异均有统计学意义（均P＜0.05）。结论    SLEDD-f联合血液灌流治疗严重脓毒症患者可纠正炎症状态，改善肾功能，恢复机体微循环功能，有助于预后改善。

• 【Abstract】Objective    To observe the effect of sustained low efficiency daily hemodiafiltration(SLEDD-f) combined with hemoperfusion on inflammatory stress, renal function and microcirculation in patients with severe sepsis. Methods    A total of 86 patients with severe sepsis admitted to Northern Theater Command General Hospital of Chinese People′s Liberation Army from January 2015 to October 2017 were randomly divided into observation group and control group, with 43 cases in each group. On the basis of routine treatment, the control group was treated with SLEDD-f and the observation group was treated with SLEDD-f combined with hemoperfusion. Vital signs, white blood cell count, serum inflammatory factors［C-reactive protein(CRP), procalcitonin, tumor necrosis factor-α(TNF-α) and Interleukin-6(IL-6)］, renal function indexes［serum creatinine and blood urea nitrogen］, sublingual microcirculation indexes［proportion of perfused vessels(PPV) and microvascular flow index(MFI)］, scores of life quality and prognosis［Sequential Organ Failure Assessment(SOFA), acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)］ were analyzed before and 7 days after treatment. Results    There were no significant differences of the indexes between groups before treatment(all P>0.05). After treatment, the observation group showed lower body temperature and white blood cell count, higher mean arterial pressure, lower levels of CRP, TNF-α, IL-6, blood urea nitrogen and serum creatinine, higher PPV and MFI, higher scores of physical function and psychological function and lower APACHEⅡ score compared to those in the control group［（36.7±0.6）℃ vs （37.6±0.6）℃, （7.7±2.0）×109/L vs （11.4±2.8）×109/L, （112±11）mmHg vs （98±10）mmHg, （10±5）mg/L vs （15±6）mg/L, （31±12）ng/L vs （37±13）ng/L, （25.5±2.8）ng/L vs （39.7±3.2）ng/L, （6.4±1.1）mmol/L vs （7.8±1.0）mmol/L, （60±5）μmol/L vs （65±6）μmol/L, （44.1±3.6）% vs （38.2±2.8）%, （2.7±0.4） vs （2.2± 1.2）, （68±8） vs (64±8）, （65±7） vs （57±6）, （10±3） vs （15±3）］, the differences were statistically significant(all P<0.05). Conclusion    SLEDL-f combined with hemoperfusion treating severe sepsis can effectively correct inflammation, improve renal function, restore microcirculation and improve the prognosis.