高容量血液滤过对多器官功能障碍综合征患者降钙素原影响的初步探讨

目的 探讨高容量血液滤过(HVHF)对多器官功能障碍综合征(MODS)患者血浆降钙素原(PCT)的影响.方法 选择MODS患者40例,随机分为对照组和HVHF组,对照组采用传统的西医治疗方法,HVHF组在传统治疗基础上行HVHF治疗,分别测定2组患者血白细胞总数(WBC)、中性粒细胞(N)百分比、血乳酸(Lac-)、血浆PCT以及APACHE Ⅱ评分.比较2组患者的病死率以及存活组和死亡组PCT、APACHE Ⅱ的差别.结果 2组患者治疗前各项指标无差别,对照组经传统西医治疗后5～7 d部分指标才开始下降(P＜0.05或P＜0.01),而HVHF组治疗后第1天各项指标即开始下降(P均＜0.05),HVHF治疗后5～7 d各项指标均显著低于对照组(P均＜0.01).HVHF组病死率明显低于对照组(P＜0.05),分别为10%和40%;存活组PCT水平、APACHE Ⅱ评分明显低于死亡组(P均＜0.01),分别为(3.8±2.6)μg/L、(7.6±3.8)分和(12.9±7.8)μg/L、(14.5 ±8.4)分.结论 HVHF能降低MODS患者的血浆PCT,降低MODS病死率,改善MODS患者预后.

Effect of high volume haemofiltration on procalcitonin in patients with multiple organ dysfunction syndrome

Objective To investigate the effect of hiigh volume haemofihration(HVHF)on plasma procalcitonin(PCT)in patients with multiple organ dysfunction syndrome(MODS).Methods 40 patients with MODS were randomly divided into control group and HVHF group.The control group received traditional west medicine therapy and the HVHF group received HVHF as well as the traditional west medicine therapy.White blood cell (WBC),neutrophil(N),PCT,lactic acid(Lac-)and APACHE Ⅱ score,were measured in both groups,the mortality in both groups wag compared.PCT and APACHE Ⅱ were also compared between the survival group and dead group.Results The above indexes had no difference between the groups before the treatment.Partial indexes in the control group decreased at 5-7 d while those decreased earlier at 1 d through 7 d in HVHF group(P＜0.05).All observed indexes at 5-7 d in the HVHF group were significantly lower than those in the control group(P＜0.01).Compared with the control group,the mortality in HVHF group wag markedly lower(10%vs 40%,P＜0.05).The level of PCT and APACHE Ⅱ score in the survival group were significantly lower than those in the dead group (3.8 4-2.6)μg/L vs(12.9 ±7.8)μg/L and 7.6±3.8 vs 14.5±8.4 respectively,P＜0.01].Conclusion HVHF could effectively decrease plasma PCT,reduce the mortality of patients with MODS and improve outcome.