早期血液净化治疗对全身炎症反应综合征及脓毒症患者治疗作用的研究

目的应用连续性血液净化技术（CBP）对全身炎症反应综合征（SIRS）及脓毒症（sepsis）患者进行治疗，探讨其对SIRS患者细胞因子及预后的影响。方法37例SIRS患者及25例sepsis患者行连续性血液净化治疗24h，于CBP治疗前0h，CBP治疗后6、12、24、36h，测血清细胞因子肿瘤坏死因子-α（TNF-α）、白介素-1（IL-1）、IL-6，同时观察治疗组CBP前后的APACHEⅡ、血乳酸、胃黏膜动脉血二氧化碳分压差（Pg-aCO2）的变化，并与对照组比较28d存活率。结果接受CBP的SIRS患者TNF-α在6、24及36h后，IL-1在36h后以及IL-6在12和36h后明显低于0h（P〈0．05）；接受CBP的sepsis患者TNF-α及IL-6 36h后明显低于0h（P〈0．05），IL-1在12、36h后明显低于0h（P〈0．05）：在36h，治疗组TNF-α、IL-1、IL-6水平较对照组明显低（P〈0．05），SIRS患者在36h的TNF-α水平明显低于sepsis患者（P〈0．05）；治疗组患者APACHEⅡ评分、血乳酸、Pg-aCO2下降（P〈0．05）；治疗组患者28d存活率明显高于对照组（62．90％vs26．67．％,P〈0．05）。结论CBP有良好的清除细胞因子效果，改善SIRS、sepsis患者的预后：在血液净化选择时机上应尽可能早。

A clinical study on early blood purification in the treatment of patients with SIRS /sepsis

Objective To evaluate the effect of continuous blood purification （CBP）on cytokines and prognosis in the treatment of patients with SIRS/sepsis. Methods 37 patients diagnosed as SIRS and25 patients diagnosed as sepsis were treated with continuous blood purification for 24 hours. The serum levels of TNF-α, IL-1 and IL-6 in CBP group were detected at 0 h, and 6,12,24,36 h after CBE APACHE Ⅱ, lactate and Pg-aCO2 were also tested. The survival rates of patients were compared between CBP group and control group. Results In SIRS group, the level of TNF-α was significantly lower at 6,24,36 h than that at 0 h（ P 〈 0.05）; the level of IL-1 was significantly lower at 36 h than that at 0 h（P 〈 0.05）, and the level of IL-6 was significantly lower at 12,36 h than that at 0 h（P 〈 0.05）. In sepsis group, there was a significant reduction of the levels of TNF-α and IL-6 at 36 h（ P 〈 0.05）, and the level of IL-6 was significantly lower at 12, 36 h than that at 0 h（P 〈 0.05）. At 36 h, there was a significant difference of the levels of TNF-α, IL-1 and IL-6 between CBP group and control group（ P 〈 0.05）, and the level of TNF-α was lower in SIRS group than that in sepsis group. After CBP treatment, APACHE Ⅱ, lactate and Pg-aCO2 declined significantly in CBP group（P〈 0.05）. Compared with control group, the survival rates of CBP group was higher（62.90% vs 26.67.%,P 〈 0.05）. Conclusion CBP is an effective therapy to remove the cytokines and improve the outcome of patients with SIRS/sepsis. The earlier to receiving CBP treatment, the better the outcome is.