血液灌流治疗脓毒症时对炎症因子的影响

［摘要］目的　观察血液灌流治疗脓毒症时炎症因子及各项临床指标的变化，探讨血液灌流在脓毒症治疗中的应用．方法　选择西安交通大学第一附属医院重症医学科重症医学科收治的脓毒症患者43例，随机分为血液灌流组（25例）和对照组（18例），治疗组除进行常规治疗外，入ICU后1 h内立即给予血液灌流治疗，每隔24 h 治疗1 次，连续治疗3 次．检测治疗组在治疗前、治疗后24 h、48 h、72 h时肿瘤坏死因子α（TNF-α）、白介素6（IL-6）、白介素10（IL-10）及血小板活化因子（PAF）的浓度．比较两组患者在治疗72 h后，TNF-α、IL-6、IL-10及PAF等炎症因子浓度的变化以及白细胞计数、C反应蛋白（CRP）、降钙素原（PCT）、血乳酸水平等临床指标的变化．结果　脓毒症早期各种炎症因子的浓度均明显升高，血液灌流治疗过程中随治疗次数增多TNF-α、IL-6、IL-10及PAF等各种炎症因子浓度均较前明显下降（P＜0.01）．72 h后治疗组患者TNF-α、IL-6及PAF浓度较对照组明显降低，CRP、PCT及血乳酸水平也明显低于对照组，2组间差异有统计学意义（P＜0.05）．结论　血液灌流能够清除脓毒症患者的炎症因子，改善临床症状．

Effect of Hemoperfusion on Inflammation Factors in Patients with Sepsis

［Abstract］Objective To observe the changes of inflammatory factors and clinical parameters on septic patients with hemoperfusion，and to discuss the application of hemoperfusion on sepsis. Methods 43 patients with sepsis were divided into treatment group and control group randomly. In the treatment group，the patients received conventional treatment and hemoperfusion together， which performed every 24 hours，continuously for 3 times when they arrived in ICU in the first hour. The concentrations of TNF-α，IL-6，IL-10 and PAF were dynamically detected before hemoperfusion， after 24 hours， 48 hours and 72 hours in treatment group. The concentrations of TNF-α，IL-6，IL-10 and PAF were compared between the two groups after 72 hours. So did the clinical parameters as WBC count，CRP，PCT and blood lactate acid. Results The concentrations of TNF-α，IL-6， IL-10 and PAF were increased significantly in the early stage of sepsis，and were decreased obviously after hemoperfusion（P < 0.01）. After 72 hours treatment， the concentrations of TNF-α，IL-6 and PAF were decreased rapidly， so did the level of CRP，PCT and blood lactate acid. There were significant differences between the two groups （P < 0.05）. Conclusion　Hemoperfusion could remove the inflammatory factor of septic patients and improve the clinical symptoms of them.