脉冲式高容量血液滤过联合血液灌流治疗脓毒性休克并发肾损伤的临床研究

目的评估脉冲式高容量血液滤过(PHVHF)联合血液灌流(HP)治疗脓毒性休克并发肾损伤患者的临床疗效。方法 2015年1月至2018年12月在江南大学附属医院明确诊断为脓毒性休克并发肾损伤住院患者36例,随机分为连续性血液滤过(CVVH)组(n=18)及PHVHF联合HP组(n=18)。对比两组病人治疗前后生命体征、生化指标、急性生理与慢性健康(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分以及去甲肾上腺素用量。采用ELISA方法检测治疗0h、2h、24h后血液及滤液白细胞介素(IL)-10,IL-6以及肿瘤坏死因子(TNF)-α的浓度。记录两组病人28 d病死率及90 d肾功能恢复情况。结果联合治疗组治疗后心率、WBC、C反应蛋白(CRP)、降钙素原(PCT)、APACHEⅡ评分、SOFA评分及去甲肾上腺素量下降优于CVVH组(P<0.05)。24 h后两组血液IL-10,IL-6以及TNF-α均有下降(P<0.05),联合治疗组效果更佳(P<0.05),HP治疗2h后即有明显下降(P<0.05),两组滤过液中均检测到以上炎症因子。联合治疗组28 d病死率为27.7%,有7例患者90 d内肾功能恢复,CVVH组病死率为38.8%,4例患者肾功能恢复。结论PHVHF联合HP可有效治疗脓毒性休克并发肾损伤。

Clinical effects of pulse high-volume hemofiltration combined with hemoperfusion on septic shock with renal injury

Objective To evaluate the clinical effects of PHVHF combined with HP on septic shock with renal injury.Methods A total of 36 cases were involved in this study and were randomly divided into two groups: PHVHF & HP group(n=18)and CVVH group(n=18). Acute physiology and chronic health evaluation(APACHE)Ⅱ score,sequential organ failure assessment(SOFA)score,vital signs, biochemical changes and the dose of norepinephrine were compared before and after the treatment. The levels of IL-6,IL-10 and TNF-α in plasma and ultrafiltrate were assessed by ELISA before and after treatment for 0 h, 2 h and 24 h. The 28-day mortalities and the recovery of renal function within 90 days were also observed. Results After treatment,the decline of heart rate(HR),white blood cell(WBC),C-reactive protein( CRP),procalcitonin(PCT),APACHE II score,SOFA score and the dose of norepinephrine in combined group was better than that in CVVH group(P<0.05). After 24 h of treatment,the levels of IL-6,IL-10 and TNF-α decreased in both groups(P < 0.05),and the decrease was more significant in HP&PHVHF group(P<0.05). After 2 h of hemoperfison,there was a significant reduction in these inflammatory factors(P < 0.05). They were also detected in the filtrate of both groups. The mortality of combined therapy group was 27.7%,while in CVVH group it was 38.8%. Renal function of 7 patients in combined group recovered within 90 days,while 4 patients in CVVH group. Conclusion HP combined with PHVHF has a significant effect on septic shock with renal injury.