高容量血液滤过、血液灌流联合血浆置换对严重创伤并发MODS患者血清TNF-α、IL-6、IL-8水平及预后的影响
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摘要
目的探讨高容量血液滤过(high volume hemo?ltration,HVHF)、血液灌流联合血浆置换对严重创伤并发多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)患者血浆肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素(interleukin,IL)-6、IL-8水平及预后的影响。方法本研究入选2015年5月至2017年6月于本院住院治疗的严重创伤逐步进展至MODS的120例患者,排除其中24例合并感染患者,最终纳入96例患者,采用随机数表法将其分为对照组(48例)和观察组(48例)。对照组患者采用HVHF治疗,观察组患者采取HVHF联合血液灌流和血浆置换治疗,比较两组患者治疗前后血清TNF-α、IL-6、IL-8水平、急性生理与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、序贯器官衰竭评估系统(sequential organ failure assessment,SOFA)评分、预后及并发症发生情况。结果治疗3个月后,两组患者血清TNF-α、IL-6、IL-8水平及APACHEⅡ评分、SOFA评分均显著低于本组治疗前(P_均<0.05),且观察组患者上述指标水平均显著低于对照组(P_均<0.05)。治疗3个月后,观察组患者死亡、植物生存、残疾的发生率均显著低于对照组(P_均<0.05),恢复良好率显著高于对照组(P <0.05),但两组患者并发症发生率无显著性差异(P> 0.05)。结论 HVHF、血液灌流联合血浆置换有助于降低严重创伤后并发MODS患者的炎性因子水平,改善预后,值得推广应用。
Objective To investigate the effect of high volume hemofiltration(HVHF), hemoperfusion combined with plasma exchange on plasma tumor necrosis factor-α(TNF-α), interleukin(IL)-6, IL-8 levels and prognosis in patients with severe trauma complicated with multiple organ dysfunction syndrome(MODS). Method In this study, 120 patients with severe trauma who were hospitalized in our hospital from May 2015 to June 2017 were enrolled in this study. Among them, 24 patients with co-infection were excluded and 96 patients were eventually included, they were randomly divided into control group(n = 48) and observation group(n =48). Control group patients were treated with HVHF, observation group patients were treated with HVHF hemoperfusion combined with plasma exchange. The levels of TNF-α, IL-6, IL-8, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment(SOFA) score, prognosis and complications were compared between the two groups before and after treatment. Result After 3 months of treatment, the levels of TNF-α, IL-6, IL-8, APACHE Ⅱ scores and SOFA scores in the two groups were signi?cantly lower than those before treatment(P_(all)< 0.05), and the levels of the above indexes in observation group were signi?cantly lower than those in control group(P_(all)< 0.05). After 3 months of treatment, the incidence rates of death, plant survival and disability in observation group were signi?cantly lower than those in control group(P_(all)< 0.05), and the good recovery rate was signi?cantly higher than that in control group(P < 0.05), however, there was no signi?cant difference in the incidence of complications between the two groups(P > 0.05). Conclusion HVHF, hemoperfusion combined with plasma exchange is helpful to reduce the level of in?ammatory factors and improve the prognosis of patients with MODS after severe trauma, which is worth popularizing and applying.
Objective To investigate the effect of high volume hemofiltration(HVHF), hemoperfusion combined with plasma exchange on plasma tumor necrosis factor-α(TNF-α), interleukin(IL)-6, IL-8 levels and prognosis in patients with severe trauma complicated with multiple organ dysfunction syndrome(MODS). Method In this study, 120 patients with severe trauma who were hospitalized in our hospital from May 2015 to June 2017 were enrolled in this study. Among them, 24 patients with co-infection were excluded and 96 patients were eventually included, they were randomly divided into control group(n = 48) and observation group(n =48). Control group patients were treated with HVHF, observation group patients were treated with HVHF hemoperfusion combined with plasma exchange. The levels of TNF-α, IL-6, IL-8, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment(SOFA) score, prognosis and complications were compared between the two groups before and after treatment. Result After 3 months of treatment, the levels of TNF-α, IL-6, IL-8, APACHE Ⅱ scores and SOFA scores in the two groups were signi?cantly lower than those before treatment(P_(all)< 0.05), and the levels of the above indexes in observation group were signi?cantly lower than those in control group(P_(all)< 0.05). After 3 months of treatment, the incidence rates of death, plant survival and disability in observation group were signi?cantly lower than those in control group(P_(all)< 0.05), and the good recovery rate was signi?cantly higher than that in control group(P < 0.05), however, there was no signi?cant difference in the incidence of complications between the two groups(P > 0.05). Conclusion HVHF, hemoperfusion combined with plasma exchange is helpful to reduce the level of in?ammatory factors and improve the prognosis of patients with MODS after severe trauma, which is worth popularizing and applying.
引文
[1]王勇强,姚芳超,王兵.多器官功能障碍综合征[J].中华急诊医学杂志,2004,23(5):126-128.
[2]Manson J,Cole E,Henry D,et al.Early changes within the lymphocyte population are associated with the development of multiple organ dysfunction syndrome in trauma patients[J].Critical Care,2016,20(1):1-10.
[3]陈德政,张勇,王明莉,等.不同血液净化模式治疗蜂蛰伤所致急性肾损伤患者的疗效分析[J].中国医学前沿杂志(电子版),2014,6(9):15-18.
[4]都定元.创伤评分的演进与AIS 2005[J].创伤外科杂志,2006,8(3):193-197.
[5]陈灏珠,林果为,王吉耀.实用内科学[M].14版.人民卫生出版社,2013.
[6]陈香美.血液净化标准操作规程[M].北京:人民军医出版社,2010.
[7]喻文,罗红敏.综合重症监护病房格拉斯哥昏迷评分主导序贯器官衰竭评分和患者30d病死率之间的关系[J].中华危重病急救医学,2014,26(10):713-713.
[8]Mcmillan T,Wilson L,Ponsford J,et al.The Glasgow Outcome Scale-40 years of application and refinement[J].Nat Rev Neurol,2016,12(8):477-485.
[9]戴蕴,王占科,乐爱平,等.严重创伤失血患者大量输血后血糖水平、多器官功能障碍综合征发生率和病死率的观察[J].解放军医药杂志,2016,28(5):83-86.
[10]张永辉,熊建琼,张彦,等.连续性血液滤过联合纳洛酮对MODS患者炎性因子水平及预后的影响[J].中国医学前沿杂志(电子版),2016,8(9):101-104.
[11]姬晓伟,陆建红,周庆,等.白细胞介素-8、C反应蛋白及降钙素原与创伤性多器官功能障碍综合征发生及预后的相关性[J].生物技术通讯,2015,26(6):830-832.
[12]程绩,尤再春,吴小程,等.序贯血液净化对严重创伤合并MODS患者炎性因子以及血流动力学的影响[J].现代生物医学进展,2018,18(5):884-888.
[13]徐宏.重症创伤救治与多器官功能障碍综合征预防[J].临床医药文献电子杂志,2015,2(30):6250-6251.
[14]刘安平,杨欠,叶鹏,等.不同血液净化方式治疗多器官功能障碍综合征的临床疗效比较[J].中国中西医结合急救杂志,2017,24(4):415-418.
[15]Abulimiti A,Husaiyin A,Sailai Y.Evaluation of HVHF for the treatment of severe acute pancreatitis accompanying MODS[J].Medicine(Baltimore),2018,97(1):e9417.
[16]杜崇军,蔡洪流,邵绍鲲,等.持续性高容量血液滤过治疗脓毒症合并多器官功能障碍综合征的效果观察[J].中华医学杂志,2015,95(3):210-213.
[17]陈玉红,郑明,李斌,等.不同连续性肾脏替代治疗模式及其剂量对脓毒症合并急性肾损伤患者溶质清除效果的研究[J].中国全科医学,2016,19(18):2145-2150.
[18]于杰,杨剑明,崔辉,等.双亲型吸附树脂血液灌流器联合血液滤过对脓毒症患者内毒素清除有效性研究[J].中华灾害救援医学,2018,6(5):14-18.
[19]饶平.血液滤过联合持续区域动脉灌流对重症急性胰腺炎治疗效果的影响[J].实用医学杂志,2015,31(14):2334-2337.
[20]曾振国,刘芬,江榕,等.高容量血液滤过用于合并急性肾损伤的多脏器功能不全综合征患者治疗时机选择[J].实用临床医学,2012,13(4):23-25.
[2]Manson J,Cole E,Henry D,et al.Early changes within the lymphocyte population are associated with the development of multiple organ dysfunction syndrome in trauma patients[J].Critical Care,2016,20(1):1-10.
[3]陈德政,张勇,王明莉,等.不同血液净化模式治疗蜂蛰伤所致急性肾损伤患者的疗效分析[J].中国医学前沿杂志(电子版),2014,6(9):15-18.
[4]都定元.创伤评分的演进与AIS 2005[J].创伤外科杂志,2006,8(3):193-197.
[5]陈灏珠,林果为,王吉耀.实用内科学[M].14版.人民卫生出版社,2013.
[6]陈香美.血液净化标准操作规程[M].北京:人民军医出版社,2010.
[7]喻文,罗红敏.综合重症监护病房格拉斯哥昏迷评分主导序贯器官衰竭评分和患者30d病死率之间的关系[J].中华危重病急救医学,2014,26(10):713-713.
[8]Mcmillan T,Wilson L,Ponsford J,et al.The Glasgow Outcome Scale-40 years of application and refinement[J].Nat Rev Neurol,2016,12(8):477-485.
[9]戴蕴,王占科,乐爱平,等.严重创伤失血患者大量输血后血糖水平、多器官功能障碍综合征发生率和病死率的观察[J].解放军医药杂志,2016,28(5):83-86.
[10]张永辉,熊建琼,张彦,等.连续性血液滤过联合纳洛酮对MODS患者炎性因子水平及预后的影响[J].中国医学前沿杂志(电子版),2016,8(9):101-104.
[11]姬晓伟,陆建红,周庆,等.白细胞介素-8、C反应蛋白及降钙素原与创伤性多器官功能障碍综合征发生及预后的相关性[J].生物技术通讯,2015,26(6):830-832.
[12]程绩,尤再春,吴小程,等.序贯血液净化对严重创伤合并MODS患者炎性因子以及血流动力学的影响[J].现代生物医学进展,2018,18(5):884-888.
[13]徐宏.重症创伤救治与多器官功能障碍综合征预防[J].临床医药文献电子杂志,2015,2(30):6250-6251.
[14]刘安平,杨欠,叶鹏,等.不同血液净化方式治疗多器官功能障碍综合征的临床疗效比较[J].中国中西医结合急救杂志,2017,24(4):415-418.
[15]Abulimiti A,Husaiyin A,Sailai Y.Evaluation of HVHF for the treatment of severe acute pancreatitis accompanying MODS[J].Medicine(Baltimore),2018,97(1):e9417.
[16]杜崇军,蔡洪流,邵绍鲲,等.持续性高容量血液滤过治疗脓毒症合并多器官功能障碍综合征的效果观察[J].中华医学杂志,2015,95(3):210-213.
[17]陈玉红,郑明,李斌,等.不同连续性肾脏替代治疗模式及其剂量对脓毒症合并急性肾损伤患者溶质清除效果的研究[J].中国全科医学,2016,19(18):2145-2150.
[18]于杰,杨剑明,崔辉,等.双亲型吸附树脂血液灌流器联合血液滤过对脓毒症患者内毒素清除有效性研究[J].中华灾害救援医学,2018,6(5):14-18.
[19]饶平.血液滤过联合持续区域动脉灌流对重症急性胰腺炎治疗效果的影响[J].实用医学杂志,2015,31(14):2334-2337.
[20]曾振国,刘芬,江榕,等.高容量血液滤过用于合并急性肾损伤的多脏器功能不全综合征患者治疗时机选择[J].实用临床医学,2012,13(4):23-25.