连续性静脉-静脉血液净化对脓毒症患者血流动力学、凝血功能及免疫功能的影响
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摘要
目的:探讨连续性静脉-静脉血液净化(CVVH)对脓毒症患者血流动力学、凝血功能及免疫功能的影响。方法:选择在医院进行CVVH治疗的112例脓毒症患者,分别在治疗前、治疗后24 h和72 h采集血液样本,检测患者的血流动力学变化、C反应蛋白(CRP)、尿素氮(BUN)、血清肌酐(Scr)、凝血酶原时间(PT)、部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、国际标准化比值(INR)等生化指标以及免疫细胞指标并观察其变化;同时评估患者的急性生理学年龄和慢性健康评估Ⅱ(APACHEⅡ)评分。结果:治疗后24 h,脓毒症患者呼吸频率和心率均有所改善,体温逐渐恢复正常,与治疗前相比,差异有统计学意义(t=26.841,t=30.457,t=51.390;P<0.05)。治疗后24 h和72 h,患者CD3+、CD4+、CD4+/CD8+细胞的百分比增加,治疗后24 h与治疗前相比,差异有统计学意义(t=7.978,t=14.750,t=5.575;P<0.05)。治疗后24 h和72 h,患者凝血功能PT、APTT、TT、FIB、INR均降低,治疗后24 h与治疗前相比,差异有统计学意义(t=7.118,t=15.631,t=3.613,t=6.745,t=4.872;P<0.05)。治疗后24 h和72 h,患者CRP、BUN、Scr均降低,治疗后24 h与治疗前相比,差异有统计学意义(t=8.303,t=13.186,t=5.721;P<0.05)。患者经治疗后24 h和72 h,患者APACHEⅡ评分有显著改善,与治疗前相比,差异有统计学意义(t=3.804,t=7.919;P<0.05)。结论:CVVH对于稳定脓毒症患者的血流动力学、重建免疫系统稳态、恢复正常的凝血功能以及改善患者的临床症状等,具有临床应用价值。
Objective: To explore the effects of continuous veno-venous hemofiltration(CVVH) on hemodynamics, coagulation function and immune function for patients with sepsis. Methods: 112 patients with sepsis who received the treatment of CVVH were enrolled in the research. All of them received blood examinations at pretreatment, 24 h post-treatment, 72 h post-treatment, respectively. And then the changes of hemodynamics, a series of coagulation function indicators included of CRP, BUN, Scr, PT, APTT, TT FIB and INR, and the changes of immune cell were measured. At the same time, the acute physiology age and chronic health evaluation(APACHEⅡ) score of them were further assessed. Results: After 24 h of treatment, the respiratory rate, heart rate and body temperature were significantly better than that of pretreatment(t=26.841, t=30.457, t=51.390, P<0.05). And the percentages of CD3+, CD4+and CD4+/CD8+cell of 24 h post treatment were significantly higher than that of pretreatment(t=7.978, t=14.750, t=5.575, P<0.05). And the differences of PT, APTT, TT, UIB and NRI between pretreatment and 24 h post treatment were significant(t=7.118, t=15.631, t=3.613, t=6.745, t=4.872, P<0.05). After 24 h and 72 h post-treatment, the CRP, BUN, Scr were decreased, and the differences of them between pretreatment and 24 h post treatment were significant(t=8.303, t=13.186, t=5.721, P<0.05). The difference of APACHEII between two groups were significant(t=3.804, t=7.919, P<0.05). Conclusion: CVVH could effectively stabilize hemodynamics of patients with sepsis, and reestablish the stable immune system, and recover normal coagulation function, and improve clinical symptoms. Therefore, it has important clinical value.
Objective: To explore the effects of continuous veno-venous hemofiltration(CVVH) on hemodynamics, coagulation function and immune function for patients with sepsis. Methods: 112 patients with sepsis who received the treatment of CVVH were enrolled in the research. All of them received blood examinations at pretreatment, 24 h post-treatment, 72 h post-treatment, respectively. And then the changes of hemodynamics, a series of coagulation function indicators included of CRP, BUN, Scr, PT, APTT, TT FIB and INR, and the changes of immune cell were measured. At the same time, the acute physiology age and chronic health evaluation(APACHEⅡ) score of them were further assessed. Results: After 24 h of treatment, the respiratory rate, heart rate and body temperature were significantly better than that of pretreatment(t=26.841, t=30.457, t=51.390, P<0.05). And the percentages of CD3+, CD4+and CD4+/CD8+cell of 24 h post treatment were significantly higher than that of pretreatment(t=7.978, t=14.750, t=5.575, P<0.05). And the differences of PT, APTT, TT, UIB and NRI between pretreatment and 24 h post treatment were significant(t=7.118, t=15.631, t=3.613, t=6.745, t=4.872, P<0.05). After 24 h and 72 h post-treatment, the CRP, BUN, Scr were decreased, and the differences of them between pretreatment and 24 h post treatment were significant(t=8.303, t=13.186, t=5.721, P<0.05). The difference of APACHEII between two groups were significant(t=3.804, t=7.919, P<0.05). Conclusion: CVVH could effectively stabilize hemodynamics of patients with sepsis, and reestablish the stable immune system, and recover normal coagulation function, and improve clinical symptoms. Therefore, it has important clinical value.
引文
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[15]付素珍,孙杰,董云.连续性血液净化对脓毒症患者免疫功能及预后的影响[J].实用医学杂志,2014,30(17):2731-2733.
[16]Hanafusa N.Application of continuous renal replacement therapy:what should we consider based on existing evidence?[J].Blood Purif,2015,40(4):312-319.
[2]Dong L,Lyu J,Ding L,et al.Advances in immunotherapeutic research of sepsis[J].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue,2017,29(2):184-187.
[3]李军,张峰利,吐尔滚·艾莎,等.血液净化对脓毒症患者凝血功能及免疫功能的影响[J].中国免疫学杂志,2016,32(11):1661-1666.
[4]Boerma EC.Retinal involvement in sepsis:from the eye of the patient to the eye of the beholder[J].Crit Care,2017,21(1):148.
[5]Prescott HC,Donnelly JP.Penalizing readmissions after sepsis could do more harm than good[J].Crit Care Med,2017,45(7):1243-1244.
[6]Dima M,Iacob D,Marginean O,et al.New emerging biological markers of neonatal sepsis[J].J Res Med Sci,2017,22:65.
[7]Inada-Kim M,Page B,Maqsood I,et al.Defining and measuring suspicion of sepsis:an analysis of routine data[J].BMJ Open,2017,7(6):e014885.
[8]张晨美,朱益飞.连续血液净化在儿童严重脓毒症中的应用[J].中华实用儿科临床杂志,2015,30(6):412-415.
[9]何婧瑜,周晓超,王庆玲,等.血栓弹力图最大血块强度值对脓毒症患者血小板减少预测价值的研究[J].中国医学装备,2017,14(6):97-102.
[10]Liu JP,Wang XW,Qie LP,et al.Disease indicators for sepsis and analysis of sepsis treatment in children using the continuous blood purification technique[J].Genet Mol Res,2015,14(2):5685-5693.
[11]马力忠,付四毛,周涛.持续血液净化对小儿脓毒症血流动力学的影响[J].广东医学,2014,35(16):2564-2566.
[12]Hashida T,Nakada TA,Satoh M,et al.Proteome analysis of hemofilter adsorbates to identify novel substances of sepsis:a pilot study[J].JArtif Organs,2017,20(2):132-137.
[13]Villa G,Neri M,Bellomo R,et al.Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications[J].Crit Care,2016,20(1):283.
[14]Iwagami M,Yasunaga H,Noiri E,et al.Potential survival benefit of polymyxin b hemoperfusion in septic shock patients on continuousrenal replacement therapy:a propensity-matched analysis[J].Blood Purif,2016,42(1):9-17.
[15]付素珍,孙杰,董云.连续性血液净化对脓毒症患者免疫功能及预后的影响[J].实用医学杂志,2014,30(17):2731-2733.
[16]Hanafusa N.Application of continuous renal replacement therapy:what should we consider based on existing evidence?[J].Blood Purif,2015,40(4):312-319.