CAJ | 학술논문

目的：研究持续静脉-静脉血液滤过（CVVH）联合血液灌流治疗对炎性因子及器官功能的影响。方法将重症脓毒血症患者81例随机分为观察组41例和对照组40例，对照组给予常规治疗方法及CVVH治疗，观察组在对照组治疗基础上给予血液灌流治疗。观察两组患者治疗前后生命体征、炎症因子水平、脏器功能及急性生理学与慢性健康状况（APACHEⅡ）评分和全身性感染相关性器官功能衰竭（SOFA）评分的变化。结果两组治疗后呼吸、心率均低于治疗前，平均动脉压高于治疗前，差异均有统计学意义（t分别=7.99、11.81、9.43；4.77、4.04、5.33；P均＜0.05），且观察组治疗后优于对照组治疗后，差异均有统计学意义（t分别=15.99、15.81、4.43，P均＜0.05）。两组治疗后肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、IL-10、丙氨酸氨基转移酶（ALT）、血肌酐（SCR）水平，以及APACHEⅡ评分、SOFA评分均低于治疗前，差异均有统计学意义（t分别=6.79、13.84、12.41、12.29、14.48、21.41、13.33；7.67、7.04、10.39、7.03、7.77、12.39、12.21，P均＜0.05）；且观察组治疗后低于对照组治疗后，差异均有统计学意义（t分别=30.89、25.11、14.93、26.11、20.89、13.66、14.93，P均＜0.05）。结论 CVVH联合血液灌流可有效清除重症脓毒血症患者血液中多种炎性介质，有助于脏器功能的保护。
목적：연구지속정맥-정맥혈액려과（CVVH）연합혈액관류치료대염성인자급기관공능적영향。방법장중증농독혈증환자81례수궤분위관찰조41례화대조조40례，대조조급여상규치료방법급CVVH치료，관찰조재대조조치료기출상급여혈액관류치료。관찰량조환자치료전후생명체정、염증인자수평、장기공능급급성생이학여만성건강상황（APACHEⅡ）평분화전신성감염상관성기관공능쇠갈（SOFA）평분적변화。결과량조치료후호흡、심솔균저우치료전，평균동맥압고우치료전，차이균유통계학의의（t분별=7.99、11.81、9.43；4.77、4.04、5.33；P균＜0.05），차관찰조치료후우우대조조치료후，차이균유통계학의의（t분별=15.99、15.81、4.43，P균＜0.05）。량조치료후종류배사인자-α（TNF-α）、백세포개소-6（IL-6）、IL-10、병안산안기전이매（ALT）、혈기항（SCR）수평，이급APACHEⅡ평분、SOFA평분균저우치료전，차이균유통계학의의（t분별=6.79、13.84、12.41、12.29、14.48、21.41、13.33；7.67、7.04、10.39、7.03、7.77、12.39、12.21，P균＜0.05）；차관찰조치료후저우대조조치료후，차이균유통계학의의（t분별=30.89、25.11、14.93、26.11、20.89、13.66、14.93，P균＜0.05）。결론 CVVH연합혈액관류가유효청제중증농독혈증환자혈액중다충염성개질，유조우장기공능적보호。
Objective To research the effect of continuous veno venous hemofiltration (CVVH) combined with hemoperfusion on inflammation and organ function in the treatment of severe sepsis. Methods A total of 81 patients with severe sepsis were randomly divided into the observation group(41 cases) and control group (40 cases).The control group was given conventional treatment and CVVH treatment while the observation group was given hemoperfusion additionally on the basis of control group. The vital signs, levels of inflammation, organ function, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sepsis related organ failure assessment (SOFA) between two groups were observed and compared. Results The breathing rate and heart rate of two groups at posttreatment were significantly lower than priori treatment while the mean arterial pressure were significantly higher (t=7.99,11.81,9.43;4.77,4.04,5.33,P<0.05). The breathing rate, heart rate and mean arterial pressure of two groups at posttreatment were statistically different (t=15.99,15.81,4.43,P<0.05).The TNF-α, IL-6, IL-10, ALT, SCR, APACHEⅡscore and SOFA score of two groups at posttreatment were significantly lower than priori treatment(t=6.79,13.84,12.41,12.29,14.48,21.41,13.33;7.67,7.04,10.39, 7.03,7.77,12.39,12.21,P<0.05)as well as compared observation group with control group at posttreatment(t=30.89,25.11, 14.93,26.11,20.89,13.66,14.93,P<0.05). Conclusion CVVH combined with hemoperfusion can effectively remove various inflammatory mediators in the blood and contribute to the protection of organ function.