CAJ | 학술논문

目的探讨高容量血液滤过(HVHF)联合容量复苏对难治性脓毒性休克并多器官功能障碍综合征(MODS)患者动脉血乳酸、炎症细胞因子以及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)、序贯器官衰竭估计系统(SOFA)评分的影响.方法 89例难治性脓毒性休克并MODS患者随机分为容量复苏组(41例)和容量复苏并HVHF组(48例),比较两组患者治疗前后动脉血乳酸及乳酸清除率、白细胞介素-6(IL-6)、降钙素原(PCT)、高敏C-反应蛋白(hs-CRP)的水平以及APACHEⅡ评分、SOFA评分的变化.结果 ①两组治疗后动脉血乳酸清除率均逐渐升高;HVHF组治疗后6、12、24 h动脉血乳酸清除率[(18.8±10.3)%、(31.6±11.4)%、(39.2±16.4)%]明显高于容量复苏组[分别为(10.7±7.5)%、(14.7±10.3)%、(16.5±10.2)%,P＜0.05或P<0.01].②两组治疗后血清IL-6、PCT、hs-CRP水平均逐渐降低,HVHF组治疗1 d、3 d时均显著低于容量复苏组(P＜0.05或P<0.01).③两组治疗后APACHEⅡ评分、SOFA评分均逐渐降低,且治疗7 d时HVHF组显著低于容量复苏组(P＜0.05和P<0.01).结论 HVHF联合容量复苏能降低难治性脓毒性休克并MODS患者动脉血乳酸、炎症细胞因子水平及APACHEⅡ评分、SOFA评分,改善患者的预后.
목적 탐토고용량혈액려과(HVHF)연합용량복소대난치성농독성휴극병다기관공능장애종합정(MODS)환자동맥혈유산、염증세포인자이급급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)、서관기관쇠갈고계계통(SOFA)평분적영향.방법 89례난치성농독성휴극병MODS환자수궤분위용량복소조(41례)화용량복소병HVHF조(48례),비교량조환자치료전후동맥혈유산급유산청제솔、백세포개소-6(IL-6)、강개소원(PCT)、고민C-반응단백(hs-CRP)적수평이급APACHEⅡ평분、SOFA평분적변화.결과 ①량조치료후동맥혈유산청제솔균축점승고;HVHF조치료후6、12、24 h동맥혈유산청제솔[(18.8±10.3)%、(31.6±11.4)%、(39.2±16.4)%]명현고우용량복소조[분별위(10.7±7.5)%、(14.7±10.3)%、(16.5±10.2)%,P＜0.05혹P<0.01].②량조치료후혈청IL-6、PCT、hs-CRP수평균축점강저,HVHF조치료1 d、3 d시균현저저우용량복소조(P＜0.05혹P<0.01).③량조치료후APACHEⅡ평분、SOFA평분균축점강저,차치료7 d시HVHF조현저저우용량복소조(P＜0.05화P<0.01).결론 HVHF연합용량복소능강저난치성농독성휴극병MODS환자동맥혈유산、염증세포인자수평급APACHEⅡ평분、SOFA평분,개선환자적예후.
Objective To evaluate the effects of high-volume hemofiltration (HVHF) and fluid resuscitation on the levels of arterial lactate and inflammatory cytokines, the acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, and sepsis-related organ failure assessment (SOFA) score in patients with refractory septic shock and multiple organ dysfunction syndrome (MODS). Methods Eighty-nine patients with refractory septic shock and MODS undergoing HVHF, fluid resuscitation were included in the trial, and they were randomly divided into fluid resuscitation group (group A, 41 cases) and HVHF and fluid resuscitation group (group B, 48 cases). The changes in arterial lactate, lactate clearance rate, interleukin-6 (IL-6), procalcitonin (PCT), high sensitivity C-reactive protein (hs-CRP), APACHEⅡ score and SOFA score in patients with refractory septic shock and MODS were determined before and after the treatment. Results ①The arterial lactate clearance rate after treatment in both groups was elevated gradually. The level of lactate clearance rate in group B at 6, 12, 24 hours [(18.8±10.3)%, (31.6±11.4)%, (39.2±16.4)%] were higher than that of group A, respectively [(10.7±7.5)%, (14.7±10.3)%, (16.5±10.2)%, P<0.05 or P<0.01]. ②The levels of pro-inflammatory cytokine IL-6, PCT and hs-CRP were reduced gradually after treatment in both groups. After treatment, the serum concentration of IL-6, PCT and hs-CRP levels in group B were reduced significantly more than that in group A at 1 day and 3 days (P<0.05 or P<0.01). ③The APACHEⅡ and SOFA scores in both groups were reduced gradually on 3 days and 7 days after treatment, but the APACHEⅡ and SOFA scores on 7 days in group B were lower compared with group A (P<0.05 and P<0.01). Conclusion HVHF and fluid resuscitation could reduce arterial lactate and cytokines contents, at the same time lower the APACHEⅡ score and SOFA score in patients with refractory septic shock and MODS, thus it could improve the survival rate of MODS patients.