高容量血液滤过联合集束化治疗对感染性休克合并MODS疗效分析

目的 探讨高容量血液滤过联合集束化治疗对感染性休克合并多器官功能障碍综合征(MODS)患者的效果。方法 选择2019年2月—2020年12月期间本院收治的119例感染性休克合并MODS患者符合本次纳入、排除标准的90例患者作为研究对象,利用分层随机分组法分为两组各45例,对照组接受集束化治疗,研究组接受高容量血液滤过联合集束化治疗,对比两组患者治疗前后APACHEⅡ评分、SOFA评分,炎症因子水平、降钙素原PCT水平和动脉血乳酸水平、乳酸清除率。结果 治疗后,研究组APACHEⅡ评分、SOFA评分(12.15±6.28,9.25±4.28)低于对照组(20.14±5.16,14.17±5.12),差异有统计学意义(t=6.594、4.946,P<0.001);治疗后,研究组血清IL-6、IL-10水平(38.25±15.24,4.21±0.89)低于对照组(64.21±18.21,6.25±1.31),研究组降钙素原PCT水平(9.81±3.94)低于对照组(11.1±4.19),差异有统计学意义(t=7.305、8.641、7.830,P<0.001);治疗后,研究组6 h、12 h、24 h乳酸清除率明显高于对照组,差异有统计学意义(χ2=5.262,P=0.002)。结论 对感染性休克合并MODS患者,采取高容量血液滤过联合集束化治疗,可以有效改善患者的APACHEⅡ评分、SOFA评分,调节患者血清炎症因子水平和PCT水平的同时,促进患者乳酸清除率的提高,临床价值明显。

Effect of high volume hemofiltration combined with bundle therapy on septic shock patients with MODS

Objective To explore the effect of high volume hemofiltration combined with bundle therapy on patients with septic shock complicated with multiple organ dysfunction syndrome (MODS). Methods A total of 90 cases of septic shock complicated with MODS in our hospital from February 2019 to December 2020 were randomly divided into two groups with 45 cases in each group. The control group received bundle therapy, and the study group received high volume hemofiltration combined with bundle therapy, and APACHEⅡ score, SOFA score, inflammatory factor level, procalcitonin PCT level, arterial blood lactate level and lactate clearance rate were compared between the two groups before and after treatment. Results After treatment, APACHEⅡ score and SOFA score in the study group (12.15±6.28, 9.25±4.28) were lower than those in the control group (20.14±5.16, 14.17±5.12), and the differences were statistically significant (t=6.594, 4.946, both P<0.05). After treatment, serum IL-6 and IL-10 levels in the study group (38.25±15.24, 4.21±0.89) were lower than those in the control group (64.21±18.21, 6.25±1.31), and procalcitonin PCT level in the study group (9.81±3.94) was lower than that in the control group (11.1±4.11), and the differences were statistically significant (t=7.305, 8.641, 7.830, all P<0.001). After treatment, the lactate clearance rates in the study group at 6h, 12h and 24h were significantly higher than those in the control group (χ2=5.262, P=0.002). Conclusion The patients with septic shock complicated with MODS, high-volume hemofiltration combined with bundle therapy can effectively improve APACHEⅡ score and SOFA score, regulate serum inflammatory factors and PCT level, and promote the improvement of lactate clearance rate, which has obvious clinical value.