连续性静脉-静脉血液滤过联合肝素治疗对脓毒性休克患者舌下微循环的影响

目的探讨连续性静脉-静脉血液滤过(CVVH)联合肝素治疗对脓毒性休克患者舌下微循环的影响。方法回顾性分析2019年1月至2020年12月福建医科大学附属闽东医院重症医学科(ICU)收治的67例脓毒性休克患者的临床资料,根据治疗方法分为两组,均予以规范化治疗,在此基础上,对照组32例予以肝素钠注射液治疗,观察组35例使用CVVH联合肝素治疗,对比两组的凝血功能、炎症因子及舌下微循环指标变化。结果治疗前两组的凝血功能、炎症因子及微循环指标比较,差异均无统计学意义(P>0.05)。治疗后,两组凝血功能以及平均动脉压(MAP)、血乳酸(Lac)及静脉-动脉血二氧化化碳分压差值(Pcv-aCO₂)均较治疗前改善(P<0.05),观察组D-二聚体及血Lac明显低于对照组,差异有统计学意义[D-二聚体(mg/L):2.66±0.79 vs.3.60±1.32,血Lac(mmol/L):1.56±0.76 vs.2.12±0.93,t=3.496、2.684,P<0.05]。观察组治疗后炎症因子[肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)]均明显低于对照组[TNF-α(pg/mL):63.76±16.11 vs.79.21±15.26;IL-6(pg/mL):124.72±30.32 vs.152.43±34.07,t=4.030、3.503,P<0.05],差异有统计学意义。治疗后72 h,两组舌下微循环指标明显改善,观察组灌注血管密度(PVD)、灌注血管比例(PPV)、微血管流动性指数(MFI)均显著高于对照组[PVD(mm/mm²):11.96±3.19 vs.9.79±2.57;PPV(%):64.94±6.81 vs.60.46±6.15;MFI:3.21±0.76 vs.2.72±0.68],差异有统计学意义(t=3.077、2.829、2.785,P均<0.05)。结论CVVH联合肝素治疗对可以显著改善脓毒性休克患者的舌下微循环。

Effect of continuous veno-venous hemofiltration combined with heparin on sublingual microcirculation in the patients with septic shock

Objective To investigate the effect of continuous veno-venous hemofiltration(CVVH)combined with heparin on sublingual microcirculation in the patients with septic shock.Methods The clinical data of 67 patients with septic shock who were treated in the ICU of our hospital from January 2019 to December 2020 were retrospectively analyzed.They were divided into two groups according to the treatment methods.All were given standardized treatment,on this basis,32 patients in the control group were treated with heparin,and 35 patients in the observation group were treated with heparin combined with CVVH.The changes of coagulation function,inflammatory factors and sublingual microcirculation were compared between the two groups.Results There were no significant differences in coagulation function,inflammatory factors and microcirculation indexes between the two groups before treatment(P>0.05).After treatment,the coagulation function,MAP,Lac and Pcv-aCO₂ of the two groups were improved significantly(P<0.05).The D-dimer and Lac in the observation group were significantly lower than those in the control group[D-dimer(mg/L):2.66±0.79 vs.3.60±1.32,Lac(mmol/L):1.56±0.76 vs.2.12±0.93],and the difference was statistically significant(t=3.496,2.684,P<0.05).TNF-αand IL-6 in the observation group were significantly lower than those in the control group[TNF-α(pg/mL):63.76±16.11 vs.79.21±15.26,IL-6(pg/mL):124.72±30.32 vs.152.43±34.07],and the difference was statistically significant(t=4.030,3.503,P<0.05).72 h after treatment,the indexes of sublingual microcirculation in both groups were significantly improved.Perfused vessel density(PVD),proportion of perfused vessels(PPV)and microvascular flow index(MFI)in the observation group were significantly higher than those in the control group[PVD(mm/mm²):11.96±3.19 vs.9.79±2.57,PPV(%):64.94±6.81 vs.60.46±6.15,MFI:3.21±0.76 vs.2.72±0.68],and the differences were statistically significant(t=3.077,2.829,2.785,P<0.05).Conclusions CVVH combined with heparin can significantly improve sublingual microcirculation in the patients with septic shock.