| 血液净化对脓毒性休克患者血清细胞因子及预后的影响 |
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| 引用本文： | 何盛琴,熊建琼,屈纪富,张雷,王涛,张永辉,张彦,陈琨.血液净化对脓毒性休克患者血清细胞因子及预后的影响[J].第三军医大学学报,2011,33(10):1061-1064. |
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| 作者姓名： | 何盛琴 熊建琼 屈纪富 张雷 王涛 张永辉 张彦 陈琨 |
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| 作者单位： | 第三军医大学西南医院急救部,重庆,400038 |
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| 基金项目： | 第三军医大学西南医院院管课题 |
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| 摘 要： | 目的研究不同血液净化方式对脓毒性休克患者血清细胞因子水平及预后的影响,探讨血液净化对脓毒性休克患者的治疗作用。方法将36例急性生理及慢性健康评分Ⅱ(APACHEⅡ评分)≥15分的脓毒性休克患者,采用随机数字表法分为对照组、连续性静脉-静脉血液滤过(continuous veno-venous hemofiltration,CVVH)组、血液灌流(hemoper-fusion,HP)+连续性静脉-静脉血液滤过组(HP+CVVH),每组12例,分别进行常规治疗、常规治疗+CVVH治疗、常规治疗+HP+CVVH治疗。检测各组治疗后不同时相点血清TNF-α、IL-6、IL-10、HMGB-1浓度,并比较各组1～7 d全身性感染相关性器官功能衰竭评价(sepsis related organ failure assessment,SOFA)评分及28 d存活率的差别。结果对照组及CVVH组TNF-α、IL-6、HMGB-1、IL-10在第1、3天各时相点浓度变化均无统计学意义(P>0.05);HP+CVVH组中HP治疗2 h后的TNF-α、HMGB-1、IL-10均有明显下降,IL-6也有一定下降,其他时相点浓度变化均无统计学意义(P>0.05)。与对照组相比,CVVH组从第4天起SOFA评分即明显降低(P<0.05),HP+CVVH组第2天起SOFA评分即明显降低(P<0.05);28 d存活率提高(对照组、CVVH组、HP+CVVH组分别为41.67%、58.33%、66.67%),且以HP+CVVH组更明显,但3组间无统计学意义。结论 CVVH对脓毒性休克患者血清TNF-α、IL-6、HMGB-1、IL-10的水平无明显影响,HP能显著降低血清TNF-α、HMGB-1、IL-10浓度;CVVH及HP+CVVH治疗均能促进脓毒性休克患者器官功能恢复,且以HP+CVVH治疗效果更佳。
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| 关 键 词： | 血液灌流 血液滤过 脓毒性休克 细胞因子 预后 |
Influence of blood purification on serum cytokine levels and prognosis in patients with septic shock |
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| He Shengqin,Xiong Jianqiong,Qu Jifu,Zhang Lei,Wang Tao,Zhang Yonghui,Zhang Yan,Chen Kun.Influence of blood purification on serum cytokine levels and prognosis in patients with septic shock[J].Acta Academiae Medicinae Militaris Tertiae,2011,33(10):1061-1064. |
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| Authors: | He Shengqin Xiong Jianqiong Qu Jifu Zhang Lei Wang Tao Zhang Yonghui Zhang Yan Chen Kun |
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| Institution: | He Shengqin,Xiong Jianqiong,Qu Jifu,Zhang Lei,Wang Tao,Zhang Yonghui,Zhang Yan,Chen Kun(Department of Emergency,Southwest Hospital,Third Military Medical University,Chongqing,400038,China) |
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| Abstract: | Objective To investigate the influence of different blood purification methods on serum cytokine levels and prognosis in patients with septic shock,and to study the therapeutic effects of different blood purification methods on the patients.Methods Thirty-six septic shock patients with acute physiology and chronic health evaluation II(APACHEII) scores not smaller than 15 were randomly divided into a control group(C group),a continuous veno-venous hemofiltration group(CVVH group),and a hemoperfusion and cont... |
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| Keywords: | hemoperfusion continuous venous-venous hemofiltration septic shock cytokine prognosis |
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