连续血液净化治疗小儿严重脓毒症临床疗效及对细胞免疫功能的影响

目的探讨连续血液净化(CBP)治疗小儿严重脓毒症的临床疗效及对细胞免疫功能的影响。方法选取2016年1月—2017年1月某院收治的严重脓毒症患儿40例,随机分为对照组和试验组,每组20例,其中对照组予以常规治疗,试验组在对照组基础上采用CBP治疗。比较两组患者治疗前后各炎性指标、免疫指标及预后情况。结果治疗前试验组与对照组患者的炎性指标(白细胞介素-6、白细胞介素-10、肿瘤坏死因子、C反应蛋白、降钙素原、白细胞计数)及免疫指标(CD3~+、CD4~+、CD4~+/CD8~+)比较,差异均无统计学意义(均P0.05)。治疗后试验组的各炎性指标均低于对照组;试验组、对照组治疗后各炎性指标均低于治疗前;差异均有统计学意义(均P0.05)。治疗后试验组各免疫指标均高于对照组;试验组、对照组治疗后各免疫指标均高于治疗前;差异均有统计学意义(均P0.05)。试验组患者PCIS评分高于对照组;试验组患者ICU转出时间、机械通气时间均短于对照组;试验组28天生存率高于对照组(95%vs 65%);试验组并发症发生率低于对照组(10%vs 45%);差异均有统计学意义(均P0.05)。结论 CBP可有效改善严重脓毒症患儿机体炎症反应,提高被抑制的细胞免疫功能,减轻病情的严重程度,改善预后。

Clinical efficacy of continuous blood purification on severe sepsis in children and effect on cellular immune function

Objective To investigate the clinical efficacy of continuous blood purification (CBP) in the treatment of severe sepsis in children and its effect on cellular immune function. Methods 40 children with severe sepsis who were admitted to a hospital from January 2016 to January 2017 were randomly divided into control group and trial group, 20 cases in each group, control group was given routine treatment, trial group was given CBP treatment on the basis of routine treatment. Inflammatory markers, immune markers, and prognosis were compared between two groups before and after treatment. Results There were no significant differences in inflammatory markers (IL-6, IL-10, TNF-a, CRP, PCT, WBC) and immune markers (CD3⁺, CD4⁺, CD4⁺/CD8⁺) between trial group and control group before treatment (all P>0.05). Inflammatory markers of trial group were all lower than control group after treatment; inflammatory markers of trial group and control group after treatment were all lower than those before treatment; differences were all statistically significant (all P<0.05). Immune markers of trial group were all higher than control group after treatment; immune markers of trial group and control group after treatment were all higher than those before treatment; differences were all statistically significant (all P<0.05). The pediatric critical illness score(PCIS score) of trial group was higher than control group; length of ICU stay and duration of mechanical ventilation of trial group were both shorter than control group; the 28-day survival rate of trial group was higher than control group (95% vs 65%); complication rate of trial group was lower than control group (10% vs 45%); difference were all statistically significant (all P<0.05). Conclusion CBP can effectively improve inflammatory response, enhance suppressed cellular immune function, alleviate the severity of disease, and improve prognosis of children with severe sepsis.