摘要
目的探讨双重血浆分子吸附系统(DPMAS)在脓毒症致多器官衰竭患者中的应用效果。方法选取河南科技大学第一附属医院2018年6月-2022年6月收治的脓毒症致多器官衰竭患者78例,简单随机化法分为观察组和对照组,各39例。两组均采用常规治疗,对照组实施连续性静脉-静脉血液滤过(CVVH),观察组在对照组基础上应用DPMAS。统计两组治疗期间病死率。对比两组治疗前、治疗3 d基本生命指标、炎性介质、辅助性T细胞(Th)1/Th2比值及肝肾功能指标。结果治疗3 d,两组心率、呼吸频率均较治疗前降低,且观察组降低更显著,差异均有统计学意义(P均<0.05)。治疗3 d,观察组和对照组心率、呼吸频率比较[(93.89±7.24)次/min vs.(98.07±8.02)次/min、(20.76±4.28)次/min vs.(23.04±4.09)次/min],差异均有统计学意义(t=2.115、2.081,P=0.039、0.042)。治疗3 d,两组肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平均较治疗前降低,且观察组降低更显著,差异均有统计学意义(P均<0.05)。治疗3 d,观察组和对照组TNF-α、CRP、IL-6水平比较[(133.97±28.99)ng/L vs.(150.26±30.24)ng/L、(74.42±12.36)ng/L vs.(81.67±13.25)ng/L、(106.45±10.38)mg/mL vs.(113.29±12.47)mg/mL],差异均有统计学意义(t=2.117、2.182、2.318,P=0.039、0.033、0.024)。治疗3 d,两组辅助性T细胞(Th)1、Th1/Th2均较治疗前升高,Th2较治疗前降低,且观察组变化更显著,差异均有统计学意义(P均<0.05)。治疗3 d,观察组和对照组组Th1、Th1/Th2、Th2比较[(1.51±0.32)%vs.(1.33±0.35)%、(0.93±0.20)vs.(0.73±0.17)、(1.62±0.38)%vs.(1.83±0.35)%],差异有统计学意义(t=2.073、4.091、2.194,P=0.043、<0.001、0.032)。治疗3 d,两组丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血肌酐(Scr)、尿素氮(BUN)水平均较治疗前降低,且观察组降低更显著,差异均有统计学意义(P均<0.05)。治疗3 d,两组ALT、AST、Scr、BUN水平比较[(126.68±18.19)U/L vs.(139.03±20.05)U/L、(140.06±23.17)U/L vs.(154.31±25.04)U/L、(173.64±20.05)μmol/L vs.(185.17±22.16)μmol/L、(10.16±3.94)mmol/L vs.(12.37±4.07)mmol/L],差异有统计学意义(t=2.493、2.280、2.109、2.123,P=0.016、0.026、0.039、0.038)。结论DPMAS可有效改善脓毒症致多器官衰竭患者生命指标及肝肾功能,清除炎性介质,提升免疫功能,且有利于降低患者死亡风险。
Objective To investigate the application effect of dual plasma molecular adsorption system(DPMAS)in patients with sepsis-induced multiple organ failure.Methods A total of 78 patients with multiple organ failure caused by sepsis admitted to the First Affiliated Hospital of Henan University of Science and Technology from June 2018 to June 2022 were selected and they were divided into control group and observation group by simple randomization,with 39 cases in each group.Both groups were given routine treatment;the control group was given continuous venous-venous hemofiltration(CVVH),and the observation group was given DPMAS on the basis of the control group.The mortality rate of the two groups during the treatment period was calculated.The basic vital indicators,inflammatory mediators and the ratio of helper T cells(Th)1/Th2 were compared between the two groups before treatment,and 3 d after treatment.Before treatment and 3 d after treatment,the liver and kidney function indexes were detected and compared between the two groups.Results After 3 days of treatment,the heart rate and respiratory rate of both groups decreased compared with those of before treatment,and the decrease was more significant in the observation group,with statistical significance(all P<0.05).After 3 days of treatment,the heart rate and respiratory rate of the control group and observation group were compared[(93.89±7.24)times/min vs.(98.07±8.02)times/min,(20.76±4.28)times/min vs.(23.04±4.09)times/min],and the differences were statistically significant(t=2.115,2.081,P=0.039,0.042).After 3 days of treatment,tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)and interleukin-6(IL-6)in 2 groups decreased compared with those before treatment,and the decreases were more significant in observation group(all P<0.05).After 3 days of treatment,TNF-α,CRP and IL-6 were compared between the two groups[(133.97±28.99)ng/L vs.(150.26±30.24)ng/L,(74.42±12.36)ng/L vs.(81.67±13.25)ng/L,(106.45±10.38)mg/mL vs.(113.29±12.47)mg/mL],the differences were statistically significant(t=2.117,2.182,2.318,P=0.039,0.033,0.024).Helper T cells(Th)1 and Th1/Th2 in both groups were higher than those before treatment,and Th2 was lower than that before treatment,and the changes were more significant in the observation group(all P<0.05).After 3 days of treatment,Th1,Th1/Th2 and Th2 in the two groups were compared[(1.51±0.32)%vs.(1.33±0.35)%,(0.93±0.20)%vs.(0.73±0.17)%,(1.62±0.38)%vs.(1.83±0.35)%],and the difference was statistically significant(t=2.073,4.091,2.194,P=0.043,<0.001,0.032).After 3 days of treatment,alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood creatinine(Scr)and urea nitrogen(BUN)in 2 groups decreased compared with those before treatment,and the decreases were more significant in observation group(all P<0.05).After 3 days of treatment,ALT,AST,Scr and BUN of the two groups were compared[(126.68±18.19)U/L vs.(139.03±20.05)U/L,(140.06±23.17)U/L vs.(154.31±25.04)U/L,(173.64±20.05)μmol/L vs.(185.17±22.16)μmol/L,(10.16±3.94)mmol/L vs.(12.37±4.07)mmol/L],the differences were statistically significant(t=2.493,2.280,2.109,2.123,P=0.016,0.026,0.039,0.038).Conclusion DPMAS could effectively improve the vital indicators and liver and kidney function in patients with sepsis-induced multiple organ failure,remove inflammatory mediators,improve immune function,and help reduce the risk of death in patients.
作者
殷瑶瑶
姜宏卫
张颖裕
王俊霞
YIN Yaoyao;JIANG Hongwei;ZHANG Yingyu;WANG Junxia(Department of Nephrology,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471003,China)
出处
《热带医学杂志》
CAS
2023年第8期1065-1069,1074,共6页
Journal of Tropical Medicine
基金
国家重点研发计划“重大慢性非传染性疾病防控研究”重点专项2018年度定向项目(2018YFC1311700)
河南省医学科技攻关计划项目(LHGJ20200590)
河南省医学科技攻关计划(联合共建)项目(LHGJ20190550)
作者简介
殷瑶瑶(1988-),女,硕士,研究方向:慢性肾脏病的防治;通信作者:王俊霞,E-mail:zr20200901@163.com
