严重烧伤早期间歇性血液滤过联合血液灌流防治脓毒症的临床研究
엄중소상조기간헐성혈액려과연합혈액관류방치농독증적림상연구
Clinical study on application of intermittent hemofiltration combined with hemoperfusion in the early stage of severe burn in the prevention and treatment of sepsis
  • 万方数据
    中华烧伤杂志 중화소상잡지
    16
    2015年 4期 248-253 ,共6页

    郭万里%雷晋%段鹏%马晓明

    곽만리%뢰진%단붕%마효명

    烧伤%脓毒症%血液滤过%血液灌注 燒傷%膿毒癥%血液濾過%血液灌註
    소상%농독증%혈액려과%혈액관주
    Burns%Sepsis%Hemofiltration%Hemoperfusion
    目的 探讨严重烧伤早期应用间歇性血液滤过联合血液灌流(HP)防治脓毒症的临床 效果. 方法 选择笔者单位2011年6月-2013年3月收治的符合入选标准的40例严重烧伤患者,采用随机数字表法分为常规治疗组和血液净化组,各20例.常规治疗组根据患者伤情按严重烧伤救治原则进行常规治疗.血液净化组患者在常规治疗基础上,于伤后3、5、7d分别行间歇性血液滤过联合HP治疗1次,每次6～8h.伤后3、5、7、10、14 d,记录患者体温、心率、呼吸频率,检测白细胞计数、中性粒细胞、尿素氮、肌酐,采用ELISA法测定血清IL-1、IL-6、TNF-α、高迁移率族蛋白B1(HMGB1)水平,采用显色基质鲎试剂法检测血清LPS水平,采用双抗夹心免疫化学发光法检测血清降钙素原(PCT)水平.治疗过程中观察脓毒症发生情况.对数据行Fisher确切概率法检验、x2检验、重复测量方差分析、LSD-t检验. 结果 (1)除伤后5d外,血液净化组患者其余时相点体温均明显低于常规治疗组(t值为1.87 ～2.97,P值均小于0.05).伤后3～14 d,血液净化组患者心率均明显慢于常规治疗组(t值为1.78 ～3.59,P值均小于0.05).除伤后3d外,血液净化组患者其余时相点呼吸频率均明显慢于常规治疗组(t值为1.93 ～2.85,P值均小于0.05).(2)伤后3～14d,血液净化组患者白细胞计数、中性粒细胞、尿素氮、肌酐均明显低于常规治疗组(t值为1.78～ 4.23,P值均小于0.05).(3)除伤后3d外,血液净化组患者其余时相点IL-1水平均明显低于常规治疗组(t值为1.97～4.16,P值均小于0.05).除伤后7d外,血液净化组患者其余时相点IL-6水平均明显低于常规治疗组(t值为2.11 ～6.34,P值均小于0.05).伤后3～14d,血液净化组患者TNF-α、HMGB1水平明显低于常规治疗组(t值为1.98 ～5.29,P值均小于0.05).(4)伤后3、5、7、10、14d,血液净化组患者LPS、PCT水平分别为(0.23±0.07)、(0.27±0.09)、(0.22±0.06)、(0.20±0.08)、(0.15±0.07) EU/mL,(0.44±0.12)、(0.67±0.13)、(0.74±0.13)、(0.64±0.12)、(0.71±0.10)ng/mL,低于常规治疗组的(0.37 ±0.08)、(0.45 ±0.09)、(0.56±0.09)、(0.48±0.08)、(0.40 ±0.08) EU/mL,(0.74±0.11)、(1.16±0.12)、(1.40±0.13)、(1.55±0.15)、(1.49±0.14)ng/mL(t值为1.88～3.43,P值均小于0.05).(5)血液净化组患者脓毒症发生率明显低于常规治疗组(x2=6.94,P＜0.01). 结论 严重烧伤早期应用间歇性血液滤过联合HP治疗,可以有效改善患者血生化指标和生命体征,降低促炎性细胞因子及LPS、PCT水平,从而减少脓毒症的发生.
    목적 탐토엄중소상조기응용간헐성혈액려과연합혈액관류(HP)방치농독증적림상 효과. 방법 선택필자단위2011년6월-2013년3월수치적부합입선표준적40례엄중소상환자,채용수궤수자표법분위상규치료조화혈액정화조,각20례.상규치료조근거환자상정안엄중소상구치원칙진행상규치료.혈액정화조환자재상규치료기출상,우상후3、5、7d분별행간헐성혈액려과연합HP치료1차,매차6～8h.상후3、5、7、10、14 d,기록환자체온、심솔、호흡빈솔,검측백세포계수、중성립세포、뇨소담、기항,채용ELISA법측정혈청IL-1、IL-6、TNF-α、고천이솔족단백B1(HMGB1)수평,채용현색기질후시제법검측혈청LPS수평,채용쌍항협심면역화학발광법검측혈청강개소원(PCT)수평.치료과정중관찰농독증발생정황.대수거행Fisher학절개솔법검험、x2검험、중복측량방차분석、LSD-t검험. 결과 (1)제상후5d외,혈액정화조환자기여시상점체온균명현저우상규치료조(t치위1.87 ～2.97,P치균소우0.05).상후3～14 d,혈액정화조환자심솔균명현만우상규치료조(t치위1.78 ～3.59,P치균소우0.05).제상후3d외,혈액정화조환자기여시상점호흡빈솔균명현만우상규치료조(t치위1.93 ～2.85,P치균소우0.05).(2)상후3～14d,혈액정화조환자백세포계수、중성립세포、뇨소담、기항균명현저우상규치료조(t치위1.78～ 4.23,P치균소우0.05).(3)제상후3d외,혈액정화조환자기여시상점IL-1수평균명현저우상규치료조(t치위1.97～4.16,P치균소우0.05).제상후7d외,혈액정화조환자기여시상점IL-6수평균명현저우상규치료조(t치위2.11 ～6.34,P치균소우0.05).상후3～14d,혈액정화조환자TNF-α、HMGB1수평명현저우상규치료조(t치위1.98 ～5.29,P치균소우0.05).(4)상후3、5、7、10、14d,혈액정화조환자LPS、PCT수평분별위(0.23±0.07)、(0.27±0.09)、(0.22±0.06)、(0.20±0.08)、(0.15±0.07) EU/mL,(0.44±0.12)、(0.67±0.13)、(0.74±0.13)、(0.64±0.12)、(0.71±0.10)ng/mL,저우상규치료조적(0.37 ±0.08)、(0.45 ±0.09)、(0.56±0.09)、(0.48±0.08)、(0.40 ±0.08) EU/mL,(0.74±0.11)、(1.16±0.12)、(1.40±0.13)、(1.55±0.15)、(1.49±0.14)ng/mL(t치위1.88～3.43,P치균소우0.05).(5)혈액정화조환자농독증발생솔명현저우상규치료조(x2=6.94,P＜0.01). 결론 엄중소상조기응용간헐성혈액려과연합HP치료,가이유효개선환자혈생화지표화생명체정,강저촉염성세포인자급LPS、PCT수평,종이감소농독증적발생.
    Objective To investigate the effects of application of intermittent hemofiltration combined with hemoperfusion (HP) in the early stage of severe burn in the prevention and treatment of sepsis.Methods Forty severely burned patients,admitted to our burn ward from June 2011 to March 2013,conforming to the study criteria,were divided into conventional treatment group (CT,n =20) and blood purification group (BP,n =20) according to the random number table.Patients in group CT received CT according to the accepted principles of treatment for a severe burn.Patients in group BP received CT and intermittent hemofiltration combined with HP once respectively on post injury day (PID) 3,5,and 7,spanning 6 to 8 hours for each treatment.On PID 3,5,7,10,and 14,body temperature,heart rate,and respiratory rate were recorded;white blood cell count (WBC),neutrophil granulocytes,blood urea nitrogen (BUN),and creatinine were determined;levels of IL-1,IL-6,TNF-α,and high-mobility group box 1 (HMGBI) in serum were determined by ELISA;level of LPS in serum was determined with the chromogenic substrate limulus amebocyte lysate method;level of procalcitonin (PCT) in serum was determined by double antibody sandwich immune chemiluminescence method.The symptoms and signs of sepsis were observed during the treatment.Data were processed with Fisher's exact test,chi-square test,analysis of variance for repeated measurement,and LSD-t test.Results (1) Except for that on PID 5,the mean body temperature of patients in group BP was significantly lower than that of group CT at each of the rest time points (with t values from 1.87 to 2.97,P values below 0.05).The heart rate was significantly slower in patients of group BP than in group CT from PID 3 to 14 (with t values from 1.78 to 3.59,P values below 0.05).Except for that on PID 3,the respiratory rate of patients in group BP was significantly slower than that of group CT at each of the rest time points (with t values from 1.93 to 2.85,P values below 0.05).(2) The levels of WBC,neutrophil granulocytes,BUN,and creatinine of patients in group BP were significantly lower than those of group CT (with t values from 1.78 to 4.23,P values below 0.05).(3) Except for that on PID 3,the level of IL-1 of patients in group BP was significantly lower than that of group CT at each of the rest time points (with t values from 1.97 to 4.16,P values below 0.05).Except for that on PID 7,the level of IL-6 of patients in group BP was significantly lower than that of group CT at each of the rest time points (with t values from 2.11 to 6.34,P values below 0.05).The levels of TNF-α and HMGB1 of patients in group BP were significantly lower than those of group CT from PID 3 to 14 (with t values from 1.98 to 5.29,P values below 0.05).(4) On PID 3,5,7,10,and 14,the levels of LPS and PCT of patients in group BP were respectively (0.23 ± 0.07),(0.27±0.09),(0.22±0.06),(0.20±0.08),(0.15±0.07) EU/mL,and (0.44±0.12),(0.67±0.13),(0.74±0.13),(0.64±0.12),(0.71 ±0.10) ng/mL,and they were lower than those of group CT [(0.37 ±0.08),(0.45 ±0.09),(0.56 ±0.09),(0.48 ±0.08),(0.40 ±0.08) EU/mL,and (0.74 ±0.11),(1.16 ±0.12),(1.40 ±0.13),(1.55 ±0.15),(1.49 ±0.14) ng/mL,with t values from 1.88 to 3.43,P values below 0.05].(5) The incidence of sepsis of patients in group BP was obviously lower than that of group CT (x 2 =6.94,P ＜ 0.01).Conclusions Intermittent hemofiltration combined with HP can effectively improve blood biochemical indexes and vital signs and reduce the occurrence of burn sepsis by decreasing the levels of proinflammatory cytokines,LPS,and PCT.
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