摘要
目的探讨双重血浆分子吸附系统在脓毒症患者治疗中的应用价值。方法回顾性选取2018年6月至2024年6月在阜阳市人民医院治疗的90例脓毒症患者作为研究对象。按照治疗方法将其不同分为两组:观察组和对照组,每组各45例。对照组采用抗脓毒症治疗,观察组在对照组治疗基础上采用双重血浆分子吸附系统治疗。比较两组患者治疗前、治疗72 h后的炎症反应指标[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏反应C蛋白(hs-CRP)、白细胞(WBC)计数、中性粒细胞(N)计数]、凝血功能指标[凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、血小板(PLT)计数]、肾功能指标(尿素氮、血肌酐、血乳酸)、病情情况评分[序贯器官衰竭评分(SOFA)、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)]差异,以及治疗结局。结果观察组治疗72 h后的IL-6、TNF-α、hs-CRP水平分别为(6.18±1.62)pg/mL、(4.40±1.33)pg/mL、(32.09±9.86)mg/L,均显著低于对照组[(7.86±1.96)pg/mL、(5.26±1.51)pg/mL、(40.66±10.73)mg/L],差异均有统计学意义(P<0.05),而两组患者WBC计数、N计数比较,差异均无统计学意义(P>0.05)。观察组治疗72 h后的PT、APTT分别为(12.81±0.95)、(35.80±3.42)s,均显著低于对照组[(13.49±1.22)、(38.51±3.89)s],差异均有统计学意义(P<0.05),而两组患者PLT计数比较,差异无统计学意义(P>0.05)。观察组治疗72 h后的尿素氮、血肌酐、血乳酸分别为(8.84±1.77)mmol/L、(98.60±13.40)μmol/L、(1.20±0.68)mmol/L,均显著低于对照组[(10.00±1.94)mmol/L、(113.60±16.20)μmol/L、(1.64±0.6)mmol/L],差异均有统计学意义(P<0.05)。观察组治疗72 h后的SOFA评分、APACHEⅡ评分分别为(8.23±1.80)、(14.89±3.20)分,均显著低于对照组[(9.44±1.94)、(16.75±3.48)分],差异均有统计学意义(P<0.05)。治疗28 d后,观察组患者的生存率为93.33%,高于对照组(75.56%),差异有统计学意义(P<0.05)。结论脓毒症患者基础治疗措施加用双重血浆分子吸附系统治疗,有利于尽快减轻炎症反应、改善凝血功能及肾功能水平,对于提高患者预后结局具有积极作用。
Objective To investigate the application value of dual plasma molecular adsorption system in the treatment of sepsis.Methods A total of 90 patients with sepsis who were treated in Fuyang People's Hospital from June 2018 to June 2024 were retrospectively selected as the study subjects.According to the different treatment methods,they were divided into two groups:the observation group and the control group,45 cases in each group.The control group was only treated with anti-sepsis treatment.The observation group was treated with double plasma molecular adsorption system on the basis of the control group.The inflammatory response indexes[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),hypersensitive C-reactive protein(hs-CRP),white blood cell(WBC)count,neutrophil(N)count],coagulation function indexes[prothrombin time(PT),activated partial prothrombin time(APTT),platelet(PLT)count],renal function indexes(urea nitrogen,serum creatinine,blood lactic acid),disease score[sequential organ failure score(SOFA),acute physiology and chronic health evaluationⅡ(APACHEⅡ)]before treatment and 72 h after treatment,and treatment outcome were compared between the two groups.Results After 72 h of treatment,the levels of IL-6,TNF-αand hs-CRP in the observation group were(6.18±1.62)pg/mL,(4.40±1.33)pg/mL and(32.09±9.86)mg/L,respectively,which were significantly lower than those in the control group[(7.86±1.96)pg/mL,(5.26±1.51)pg/mL,(40.66±10.73)mg/L],the differences were statistically significant(P<0.05).There were no statistically significant difference in WBC count and N count between the two groups(P>0.05).The PT and APTT of the observation group after 72 h of treatment were(12.81±0.95)and(35.80±3.42)s,respectively,which were significantly lower than those of the control group[(13.49±1.22)and(38.51±3.89)s],the differences were statistically significant(P<0.05).There was no statistically significant difference in PLT count between the two groups(P>0.05).The urea nitrogen,serum creatinine and blood lactic acid in the observation group after 72 h of treatment were(8.84±1.77)mmol/L,(98.60±13.40)μmol/L and(1.20±0.68)mmol/L,respectively,which were significantly lower than those in the control group[(10.00±1.94)mmol/L,(113.60±16.20)μmol/L,(1.64±0.6)mmol/L],and the differences were statistically significant(P<0.05).The SOFA score and APACHEⅡscore of the observation group after 72 h of treatment were(8.23±1.80)and(14.89±3.20)points,respectively,which were significantly lower than those of the control group[(9.44±1.94)and(16.75±3.48)points],the differences were statistically significant(P<0.05).After 28 d of treatment,the survival rate of the observation group was 93.33%,which was higher than that of the control group(75.56%),and the difference was statistically significant(P<0.05).Conclusion The basic treatment of sepsis patients with dual plasma molecular adsorption system is conducive to reducing inflammation,improving coagulation function and renal function,and has a positive effect on improving the prognosis of patients.
作者
刘成
赵停停
孙振康
方明
李东风
LIU Cheng;ZHAO Ting-ting;SUN Zhen-kang(Department of Critical Care Medicine,Fuyang People's Hospital,Fuyang Anhui 236000,China)
出处
《临床和实验医学杂志》
2025年第9期909-913,共5页
Journal of Clinical and Experimental Medicine
基金
安徽省临床医学研究转化专项项目(编号:202304295107020046)。
关键词
双重血浆分子吸附系统
脓毒症
炎症反应
凝血功能
肾功能
Dual plasma molecular adsorption system
Sepsis
Inflammatory response
Coagulation function
Renal function
作者简介
通信作者:李东风,Email:gxykd06@163.com。
