目的 观察连续血液净化治疗脓毒症的临床疗效.方法 92例脓毒症患者依据治疗方法分为观察组与对照组,对照组46例采用常规方法治疗,观察组46例在常规治疗基础上加用连续血液净化进行治疗.观察两组治疗前、治疗后3 d心率(HR)、平均动脉压(MAP)、氧合指数[动脉血氧分压(PaO 2)/吸入氧浓度(FiO 2)]、血清乳酸水平、急性生理学及慢性健康状况Ⅱ(APACHEⅡ)评分等变化情况,比较两组治疗前、治疗后3 d C-反应蛋白(CRP)、血清降钙素原(PCT)、白细胞介素-6(IL-6)等炎性指标变化情况.观察比较两组治疗后4周病死率.结果 治疗后3 d,两组心率、平均动脉压、氧合指数均明显好转(P<0.05),血清乳酸水平、APACHEⅡ评分降低(P<0.05);且观察组氧合指数高于对照组,血清乳酸水平、APACHEⅡ评分低于对照组,两组比较差异有统计学意义(P<0.05).两组治疗后CRP、PCT、IL-6等炎性指标均低于治疗前,差异有统计学意义(P<0.05);且观察组低于对照组,差异有统计学意义(P<0.05).治疗后4周,观察组病死率低于对照组,差异有统计学意义(P<0.05).结论 连续血液净化可以有效改善机体全身炎症反应,降低患者病死率,值得临床推广应用.
Objective To observe the clinical efficacy of continuous blood purification on the treatment of sepsis. Methods Ninety-two patients with sepsis were divided into observation group and control group according to the therapy regimens . Patients in control group were treated by conventional treatment,and patients in observation group were treated by continuous blood purification on the basis of conventional therapy. Heart rate (HR),mean arterial pressure (MAP),PaO 2 / FiO2 ,serum lactic acid level,acute physiology and chronic health evaluation-Ⅱ (APACHE Ⅱ)score in the two groups before and 3 d after treatment were observed. The levels of C-reactive protein (CRP),procalcitonin (PCT)and interleukin-6 (IL-6)in the two groups before and 3 d after treatment were compared,and the fatality rates of the two groups 4 weeks after treatment were compared. Results Three days after treatment, HR,MAP,PaO 2 / FiO2 of the two groups were significantly improved (P < 0. 05),serum lactic acid level and APACHE Ⅱ score significantly decreased (P < 0. 05);compared with control group,the PaO 2 / FiO2 of observation group was significantly higher than that of control group,the serum lactic acid level and A-PACHE Ⅱ score were significant lower than those of control group (P < 0. 05). After treatment,the lev-els of CRP,PCT and IL-6 in the two groups were significantly lower than those before treatment (P <0. 05);and those indexes in observation group were significantly lower than those in control group (P <0. 05). After 4 weeks of treatment,the fatality rate of observation group was significantly lower than that of control group (P < 0. 05). Conclusions Continuous blood purification can effectively improve the body's systemic inflammatory response,reduce fatality rate,which is worthy of clinical application.