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.
引文
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