标题：连续性血液净化对严重脓毒症患者炎症因子、血流动力学及免疫功能的影响

      作者：郭亚红 1，马小红 2，李清 1，李红兵 3，罗兵 4    (1.渭南市中心医院急诊科，陕西 渭南 714000；2.渭南市中心医院病案室，陕西 渭南 714000；3.渭南市中心医院感染科，陕西 渭南 714000；4.安康市中心医院综合内科，陕西 安康 725000)

      卷次： 2018年29卷23期

      【摘要】 目的 探讨连续性血液净化对严重脓毒症患者炎症因子、血流动力学及免疫功能的影响。方法 选择渭南市中心医院2014年1月至2017年12月期间收治的56例严重脓毒症患者为研究对象，根据随机数表法将患者分为观察组和对照组，每组28例，对照组给予常规抗感染等治疗，观察组在此基础上联合应用连续性血液净化，比较治疗前及治疗3 d后两组患者的炎症因子、血流动力学[包括平均动脉压(MAP)、心率(HR)及全身血管阻力指数(SVRI)]及免疫功能(CD4+/ CD8+)水平。结果 治疗3 d后，观察组患者的血清肿瘤坏死因子-α (TNF-α)及白细胞介素-6 (IL-6)水平分别为(99.45±22.18) pg/mL、(146.71±29.46) pg/mL，明显低于对照组的(120.26±25.35) pg/mL、(168.73±27.48) pg/mL，CD4+/ CD8+水平为(1.48±0.22)，明显高于对照组的(1.35±0.18)，差异均有统计学意义(P<0.05)；观察组与对照组组患者MAP及 SVRI分别为(95.08±20.63) mmHg、(106.52±10.39)和(93.54±22.69) mmHg、(91.47±12.62)，均较治疗前明显升高，HR则分别为(90.08±12.83)次/min、(93.34±13.26)次/min，均较治疗前明显降低，差异均有统计学意义(P<0.05)；且治疗后，观察组SVRI水平为(106.52±10.39)，明显高于对照组的(91.47±12.62)，差异有统计学意义 (P<0.05)；观察组患者的病死率为 17.86%，与对照组的 25.00%比较差异无统计学意义(P>0.05)。结论 连续性血液净化治疗严重脓毒症可有效降低炎症因子水平，维持血流动力学的稳定，改善免疫功能。
      【关键词】 脓毒症；连续性血液净化；炎症因子；血流动力学；免疫功能
      【中图分类号】 R631 【文献标识码】 A 【文章编号】 1003—6350（2018）23—3260—03

Effect of continuous blood purification on inflammatory factors, hemodynamics and immune function in patientswith severe sepsis.
GUO Ya-hong 1, MA Xiao-hong 2, LI Qing 1, LI Hong-bing 3, LUO Bing 4. 1. Department of Emergency,Weinan Central Hospital, Weinan 714000, Shaanxi, CHINA; 2. Department of Medical Record, Weinan Central Hospital,Weinan 714000, Shaanxi, CHINA; 3. Department of Infectious Disease, Weinan Central Hospital, Weinan 714000, Shaanxi,CHINA; 4. Department of Comprehensive Internal Medicine, Ankang Central Hospital, Ankang 725000, Shaanxi, CHINA
【Abstract】 Objective To investigate the effects of continuous blood purification on inflammatory factors, he-modynamics and immune function in patients with severe sepsis. Methods A total of 56 patients with severe sepsistreated in the Weinan Central Hospital from January 2014 to December 2017 were enrolled in the study. They were ran-domly divided into a control group (n=28) and an observation group (n=28) according to the random number table meth-ods. The control group was treated with routine anti-infective treatment, and the observation group was treated with con-tinuous blood purification on the above basis. The inflammatory factors and hemodynamics (including mean arterial pres-sure [MAP], heart rate [HR] and systemic vascular resistance index [SVRI]) and immune function (CD4+/CD8+) levelswere compared between the two groups before treatment and after three days of treatment. Results After 3 days oftreatment, the serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the observation group were(99.45±22.18) pg/mL and (146.71±29.46) pg/mL, respectively, which were significantly lower than (120.26±25.35) pg/mLand (168.73±27.48) pg/mL in the control group; the ratio of CD4+/CD8+ in the observation group was (1.48±0.22), whichwas significantly higher than (1.35±0.18) in the control group; all differences were statistically significant (P<0.05). Aftertreatment, the MAP and SVRI iin the observation group and the control group were (95.08±20.63) mmHg, (106.52±10.39)and (93.54±22.69) mmHg, (91.47±12.62), respectively, which were significantly higher than those before treatment; theHR was (90.08±12.83) times/min and (93.34±13.26) times/min, respectively, which were significantly lower than thosebefore treatment; all differences were statistically significant (P<0.05). And the SVRI level of the observation group(106.52±10.39) was significantly higher than (91.47±12.62) in the control group (P<0.05). The mortality rate in the ob-servation group was 17.86%, which was similar with 25.00% in the control group (P>0.05). Conclusion Continuousblood purification in the treatment of severe sepsis can effectively reduce the levels of inflammatory factors, maintainthe stability of hemodynamics, and improve the immune function.
      【Key words】 Sepsis; Continuous blood purification; Inflammatory factors; Hemodynamics; Immune function