间断性血液灌流和连续性血液滤过治疗脓毒症的疗效比较_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 颉永乐 ¹ ,  刘健 ² , 杜毅君 ¹ , 苏文涛 ¹ , 卿楠 ¹ , 辛宏伟 ¹

1. ;
2. ;

Corresponding author：

刘健, Email: medecinliu@sina.com

Keywords：

血液灌流; 血液滤过; 脓毒症; 炎症介质

DOI：

10.7507/1007-9424.20150225

Video：

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目的探讨血液灌流（hemoperfusion，HP）和连续性静脉-静脉血液滤过（continuous veno-venous hemofiltration，CVVH）治疗脓毒症患者的临床疗效。方法采用随机对照研究方法，将天水市第一人民医院重症监护病房（ICU）2012～2014年期间收治的67例革兰阴性脓毒症患者按抽签法随机分为常规治疗组（24例）、HP治疗组（18例）及CVVH治疗组（25例）3组，观察3组患者治疗前和治疗后24、48及72 h的心率（HR）、平均动脉压（MAP）、APACHEⅡ评分、降钙素原（PCT）、C反应蛋白（CRP）和血清内毒素（ET）水平的变化。结果治疗后24、48及72 h CVVH治疗组的各项指标改善均较常规治疗组和HP治疗组明显（P<0.05）；HP治疗组仅在治疗后24 h各项指标相较于常规治疗组下降（P<0.05），但在治疗后48及72 h时与常规治疗组相比差异无统计学意义（P>0.05）。结论 HP和CVVH都能不同程度地降低炎症介质，但以CVVH治疗的效果更明显；脓毒症的转归可能有更多的影响因素。

Citation： 颉永乐, 刘健, 杜毅君, 苏文涛, 卿楠, 辛宏伟. 间断性血液灌流和连续性血液滤过治疗脓毒症的疗效比较. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(7): 863-866. doi: 10.7507/1007-9424.20150225 Copy

1.	Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med, 2013, 39(2):165-228.
2.	Ronco C, Tetta C, Mariano F, et al. Interpreting the mechanisms of continuous renal replacement therapy in sepsis:the peakconcentration hypothesis. Artif Organs, 2003, 27(9):792-801.
3.	季大玺, 龚德华, 刘斌. 连续性血液净化在重症监护病房中的应用. 中华医学杂志, 2002, 82(18):1291-1294.
4.	Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure:a prospective randomized trial. Lancet, 2000, 356 (9223):26-30.
5.	Honore PM, Jamez J, Wauthier M, et al. Prospective evaluation of short-term, high-volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock. Crit Care Med, 2000, 28(11):3581-3587.
6.	Tsuchida K, Yoshimura R, Nakatani T, et al. Blood purification for critical illness:cytokines adsorption therapy. Ther Apher Dial, 2006, 10(1):25-31.
7.	Kunitomo T, Shoji HT, Pirenne B, et al. Endotoxin removal by toraymixin. Contrib Nephrol, 2001, 132:415-420.
8.	Hussein MH, Kato T, Sugiura T, et al. Effect of hemoperfusion using polymyxin B-immobilized fiber on IL-6, HMGB-1, and IFN gamma in a neonatal sepsis model. Pediatr Res, 2005, 58(2):309-314.
9.	Ruberto F, Pugliese F, D'Alio A, et al. Clinical effects of direct hemoperfusion using a polymyxin-B immobilized column in solid organ transplanted patients with signs of severe sepsis and septic shock. A pilot study. Int J Artif Organs, 2007, 30(10):915-922.
10.	Cruz DN, Bellomo R, Ronco C. Clinical effects of polymyxin B-immobilized fiber column in septic patients. Contrib Nephrol, 2007, 156:444-451.
11.	黄昭, 王思荣, 刘继云. 血液灌流治疗对脓毒症急性肾损伤患者炎症因子的清除及肾脏保护作用. 中华急诊医学杂志, 2011, 20(1):60-64.
12.	杜斌, 陈德昌, 潘家绮, 等. 降钙素原与白介素-6的相关性优于传统的炎症指标. 中国危重病急救医学, 2002, 14(8):474-477.
13.	陈炜, 赵磊, 牛素平, 等. 不同炎症因子对细菌性血流感染所致脓毒症患者的早期诊断价值. 中国危重病急救医学, 2014, 26(3):165-170.
14.	陈炜, 李丽娟, 古旭云, 等. 动态监测外周血降钙素原水平对脓毒性休克患者预后的预测价值. 中国危重病急救医学, 2012, 24(8):470-473.
15.	Póvoa P, Almeida E, Moreira P, et al. C-reactive Protein as an indicator of sepsis. Intensive Care Med, 1998, 24(10):1052-1056.
16.	Lannergård A, Larsson A, Friman G, et al. Human serum amyloid A (SAA) and high sensitive C-reactive protein (hsCRP) in preterm newborn infants with nosocomial infections. Acta Paediatr, 2008, 97(8):1061-1065.
17.	赵世峰, 沈洪. 内毒素血症早期治疗的基础研究. 世界急危重病医学杂志, 2007, 4(3):1884-1888.
18.	Nakamura T, Kawagoe Y, Suzuki T, et al. Polymyxin B-immobilized fiber hemoperfusion with the PMX-05R column in elderly patients suffering from septic shock. Am J Med Sci, 2007, 334(4):244-247.
19.	Kushi H, Miki T, Okamaoto K, et al. Early hemoperfusion with an immobilized polymyxin B fiber column eliminates humoral mediators and improves pulmonary oxygenation. Crit Care, 2005, 9(6):R653-R661.
20.	Tsushima K, Kubo K, Yoshikawa S, et al. Effects of PMX-DHP treatment for patients with directly induced acute respiratory distress syndrome. Ther Apher Dial, 2007, 11(2):138-145.
21.	Dahaba AA, EI-Awady GA, Rehak PH, et al. Procalcitonin and proinflammatory cytokine clearance during continuous venovenous haemofiltration in septic patients. Anaesth Intensive Care, 2002, 30(3):269-274.

1. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med, 2013, 39(2):165-228.
2. Ronco C, Tetta C, Mariano F, et al. Interpreting the mechanisms of continuous renal replacement therapy in sepsis:the peakconcentration hypothesis. Artif Organs, 2003, 27(9):792-801.
3. 季大玺, 龚德华, 刘斌. 连续性血液净化在重症监护病房中的应用. 中华医学杂志, 2002, 82(18):1291-1294.
4. Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure:a prospective randomized trial. Lancet, 2000, 356 (9223):26-30.
5. Honore PM, Jamez J, Wauthier M, et al. Prospective evaluation of short-term, high-volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock. Crit Care Med, 2000, 28(11):3581-3587.
6. Tsuchida K, Yoshimura R, Nakatani T, et al. Blood purification for critical illness:cytokines adsorption therapy. Ther Apher Dial, 2006, 10(1):25-31.
7. Kunitomo T, Shoji HT, Pirenne B, et al. Endotoxin removal by toraymixin. Contrib Nephrol, 2001, 132:415-420.
8. Hussein MH, Kato T, Sugiura T, et al. Effect of hemoperfusion using polymyxin B-immobilized fiber on IL-6, HMGB-1, and IFN gamma in a neonatal sepsis model. Pediatr Res, 2005, 58(2):309-314.
9. Ruberto F, Pugliese F, D'Alio A, et al. Clinical effects of direct hemoperfusion using a polymyxin-B immobilized column in solid organ transplanted patients with signs of severe sepsis and septic shock. A pilot study. Int J Artif Organs, 2007, 30(10):915-922.
10. Cruz DN, Bellomo R, Ronco C. Clinical effects of polymyxin B-immobilized fiber column in septic patients. Contrib Nephrol, 2007, 156:444-451.
11. 黄昭, 王思荣, 刘继云. 血液灌流治疗对脓毒症急性肾损伤患者炎症因子的清除及肾脏保护作用. 中华急诊医学杂志, 2011, 20(1):60-64.
12. 杜斌, 陈德昌, 潘家绮, 等. 降钙素原与白介素-6的相关性优于传统的炎症指标. 中国危重病急救医学, 2002, 14(8):474-477.
13. 陈炜, 赵磊, 牛素平, 等. 不同炎症因子对细菌性血流感染所致脓毒症患者的早期诊断价值. 中国危重病急救医学, 2014, 26(3):165-170.
14. 陈炜, 李丽娟, 古旭云, 等. 动态监测外周血降钙素原水平对脓毒性休克患者预后的预测价值. 中国危重病急救医学, 2012, 24(8):470-473.
15. Póvoa P, Almeida E, Moreira P, et al. C-reactive Protein as an indicator of sepsis. Intensive Care Med, 1998, 24(10):1052-1056.
16. Lannergård A, Larsson A, Friman G, et al. Human serum amyloid A (SAA) and high sensitive C-reactive protein (hsCRP) in preterm newborn infants with nosocomial infections. Acta Paediatr, 2008, 97(8):1061-1065.
17. 赵世峰, 沈洪. 内毒素血症早期治疗的基础研究. 世界急危重病医学杂志, 2007, 4(3):1884-1888.
18. Nakamura T, Kawagoe Y, Suzuki T, et al. Polymyxin B-immobilized fiber hemoperfusion with the PMX-05R column in elderly patients suffering from septic shock. Am J Med Sci, 2007, 334(4):244-247.
19. Kushi H, Miki T, Okamaoto K, et al. Early hemoperfusion with an immobilized polymyxin B fiber column eliminates humoral mediators and improves pulmonary oxygenation. Crit Care, 2005, 9(6):R653-R661.
20. Tsushima K, Kubo K, Yoshikawa S, et al. Effects of PMX-DHP treatment for patients with directly induced acute respiratory distress syndrome. Ther Apher Dial, 2007, 11(2):138-145.
21. Dahaba AA, EI-Awady GA, Rehak PH, et al. Procalcitonin and proinflammatory cytokine clearance during continuous venovenous haemofiltration in septic patients. Anaesth Intensive Care, 2002, 30(3):269-274.

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间断性血液灌流和连续性血液滤过治疗脓毒症的疗效比较

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