高容量血液滤过并容量复苏对脓毒性休克血乳酸及炎症因子清除作用的研究

目的 探讨高容量血液滤过(HVHF)联合容量复苏对难治性脓毒性休克并多器官功能障碍综合征(MODS)患者动脉血乳酸、炎症细胞因子以及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)、序贯器官衰竭估计系统(SOFA)评分的影响.方法 89例难治性脓毒性休克并MODS患者随机分为容量复苏组(41例)和容量复苏并HVHF组(48例),比较两组患者治疗前后动脉血乳酸及乳酸清除率、白细胞介素-6(IL-6)、降钙素原(PCT)、高敏C-反应蛋白(hs-CRP)的水平以及APACHEⅡ评分、SOFA评分的变化.结果 ①两组治疗后动脉血乳酸清除率均逐渐升高;HVHF组治疗后6、12、24 h动脉血乳酸清除率(18.8±10.3)%、(31.6±11.4)%、(39.2±16.4)%]明显高于容量复苏组分别为(10.7±7.5)%、(14.7±10.3)%、(16.5±10.2)%,P＜0.05或P<0.01].②两组治疗后血清IL-6、PCT、hs-CRP水平均逐渐降低,HVHF组治疗1 d、3 d时均显著低于容量复苏组(P＜0.05或P<0.01).③两组治疗后APACHEⅡ评分、SOFA评分均逐渐降低,且治疗7 d时HVHF组显著低于容量复苏组(P＜0.05和P<0.01).结论 HVHF联合容量复苏能降低难治性脓毒性休克并MODS患者动脉血乳酸、炎症细胞因子水平及APACHEⅡ评分、SOFA评分,改善患者的预后.

Study the effects of high-volume hemofiltration and fluid resuscitation on removing blood lactic acid and pro-inflammatory cytokines in patients with refractory septic shock

Objective To evaluate the effects of high-volume hemofiltration (HVHF) and fluid resuscitation on the levels of arterial lactate and inflammatory cytokines, the acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, and sepsis-related organ failure assessment (SOFA) score in patients with refractory septic shock and multiple organ dysfunction syndrome (MODS). Methods Eighty-nine patients with refractory septic shock and MODS undergoing HVHF, fluid resuscitation were included in the trial, and they were randomly divided into fluid resuscitation group (group A, 41 cases) and HVHF and fluid resuscitation group (group B, 48 cases). The changes in arterial lactate, lactate clearance rate, interleukin-6 (IL-6), procalcitonin (PCT), high sensitivity C-reactive protein (hs-CRP), APACHEⅡ score and SOFA score in patients with refractory septic shock and MODS were determined before and after the treatment. Results ①The arterial lactate clearance rate after treatment in both groups was elevated gradually. The level of lactate clearance rate in group B at 6, 12, 24 hours (18.8±10.3)%, (31.6±11.4)%, (39.2±16.4)%] were higher than that of group A, respectively (10.7±7.5)%, (14.7±10.3)%, (16.5±10.2)%, P<0.05 or P<0.01]. ②The levels of pro-inflammatory cytokine IL-6, PCT and hs-CRP were reduced gradually after treatment in both groups. After treatment, the serum concentration of IL-6, PCT and hs-CRP levels in group B were reduced significantly more than that in group A at 1 day and 3 days (P<0.05 or P<0.01). ③The APACHEⅡ and SOFA scores in both groups were reduced gradually on 3 days and 7 days after treatment, but the APACHEⅡ and SOFA scores on 7 days in group B were lower compared with group A (P<0.05 and P<0.01). Conclusion HVHF and fluid resuscitation could reduce arterial lactate and cytokines contents, at the same time lower the APACHEⅡ score and SOFA score in patients with refractory septic shock and MODS, thus it could improve the survival rate of MODS patients.