直接中性树脂血液灌流早期辅助治疗脓毒症

评价采用中性大孔径吸附树脂的直接血液灌流(DHP)早期辅助治疗脓毒症的临床疗效及安全性。方法 72例脓毒症患者随机分为DHP组与对照组,最终69例完成本研究。入选患者均予脓毒症集束化治疗,DHP组患者在入组后即予DHP治疗。采用美国Baxter床旁连续性血液净化机和HA330血液灌流器治疗,使用低分子肝素抗凝,每次治疗2.5 h,每隔24h治疗1次,连续治疗3次。两组患者分别于治疗前及治疗后第3、7、14、28天监测急性生理功能和慢性健康状况评分Ⅱ(APACHEⅡ)、氧合指数(OI)、平均动脉压(MAP)、C反应蛋白(CRp)、血清IL-6和IL-10水平、白细胞计数(WBC)、血红蛋白浓度(Hb)和血小板计数(PLT),并观察患者28 d病死率、多巴胺用量、机械通气时间、连续性肾替代治疗(CRRT)治疗时间及并发症情况。结果 入选患者均能耐受DHP治疗,无并发症发生。DHP组28 d病死率低于对照组[48.6％ (17/35)比73.5％ (25/34),P＜0.05],且ICU停留时间[(13.8±3.7)d比(19.3±4.2)d]、机械通气时间[(141.7±67.0)h比(180.4±86.8)h]、CRRT治疗时间[(73.3±17.0)h比(90.9±18.0) h]也低于对照组(均为P＜0.05)。治疗后3d、7d,DHP组的APACHEⅡ评分、多巴胺用量、CRP及血清IL-6水平均低于对照组(P＜0.05),而OI和MAP高于对照组(P＜0.05),但血清IL-10水平、WBC、Hb及PLT比较差异均无统计学意义。治疗后14d、28d,两组间APACHEⅡ评分、OI、MAP、CRP、血清IL-6和IL-10水平、WBC、Hb和PLT比较差异均无统计学意义。结论 DHP早期辅助治疗脓毒症患者可降低28 d病死率,缩短ICU停留时间,减少机械通气及RRT治疗时间,并可降低循环中炎性介质水平,有效改善脏器功能,有利于脓毒症患者预后。

Early direct hemoperfusion with neutral macroporous resin as an adjuvant treatment of sepsis

Objective To evaluate the clinical efficacy and safety dearly direct hemoperfusion with neutral macroporous resin (NS-DHP) for treatment of sepsis. Methods Seventy-two cases of sepsis were randomized into DHP group [n=35, aged (67.3±9.8) years]and control group [n=34, aged (63.3±10.5) years].Sisty-nine patients completed the trial. All the patients received sepsis bundles, while the DHP group underwent additionally NS-DHP immediately alter randomization. Treatment with portable continuous hemofiltration machine (USA, Baxter ) and HA330 hemopeffusion apparatus was carried out once every 24 hours for 3 consecutive times,each session lasting 2.5 hours. Before and at 3, 7, 14, and 28 days of treatment, acute physiology and chronic health evaluation (APCHE Ⅱ ), oxygenation index (0I), mean arterial pressure (MAP), C-reactive protein (CRP), serum levels of IL-6 and IL-10, white blood cell count (WBC), hemoglobin concentration (Hb) and platelet count (PLT) were measured. Moreover, 28-day mortality, use of dopamine, duration of mechanical ventilation and continuous renal replacement therapy(CRRT), as well as complications, were recorded. Results Treatment with NS-DHP was well tolerated without any complication. Compared with the control group, DHP group showed lower 28-day mortality [48.6％ (17/35) vs 73.5％ (25/34), P＜0.05], shorter 1CU stay [( 13.8±3.7)d vs ( 19.3±4.2)d], durations of mechanical ventilation [(141.7±67.0) h vs (180.4±86.8) h]and CRRT [(73.3±17.0) h vs (90.9±18.0) h](P＜0.05). On days 3 and 7 of the treatment, the DHP group showed significantly lower APCHE Ⅱ score, dopamine use, serum levels of IL-6 and CRP(P＜0.05), higher OI and MAP (P＜0.05) as compared with the control group. The serum levels of IL- 10, WBC count, Hb and PLT did not differ between the two groups. Conclusions Early NS-DHP as an adjuvant treatment in septic patients can reduce 28-day mortality,shorten the duration of mechanical ventilation and RRT, and reduce the levels of circulating inflammatory mediators. Therefore, NS-DHP can help improve organ functions and prognosis for patients with sepsis.