连续性血浆滤过吸附治疗严重感染并多脏器功能障碍综合征的临床效果

目的 研究连续性血浆滤过吸附（CPFA）治疗严重感染并多脏器功能障碍综合征（MODS）的临床效果.方法 选择2011年1月～2013年12月本院ICU收治的48例患者,将患者随机分为观察组和对照组,每组各24例.在相同基础治疗的基础上,观察组给予CPFA联合高容量血液滤过（HVHF）治疗,对照组仅行HVHF治疗.观察患者的生命体征变化,行血、肾、血气常规检测,并检测治疗即刻、5h、10h的肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、C-反应蛋白（CRP）水平,以评价治疗的安全性及临床疗效.结果 两组治疗后的生命体征、生化指标及APACHEⅡ评分比较,差异无统计学意义（P＞0.05）;两组治疗即刻的TNF-α、IL-6、CRP水平比较,差异无统计学意义（P＞0.05）,观察组治疗5、10 h的TNF-α、IL-6、CRP水平均显著低于对照组（P＜0.05）.结论 CPFA在降低致炎性细胞因子水平、提升抗炎/致炎因子水平方面的效果显著,对严重感染并MODS患者具有显著的临床意义,值得推广.

Clinical effect of continuous plasma filtration adsorption in the treatment of serious infection complicated with multiple organ dysfunction syndrome

Objective To study the clinical effect of continuous plasma filtration adsorption （CPFA） in the treatment of severe infection complicated with multiple organ dysfunction syndrome （MODS）. Methods 48 cases treated by ICU in our hospital from January 2011 to December 2013 were selected and randomly divided into the observation group （n= 24） and the control group （n=24）.On the basis of the same basic treatment,the observation group was treated with CPFA combined with high volume hemofihration （HVHF）,the control group was treated with HVHF.The change of vital sign of patients was observed,and the regular detection of blood,kidney and blood gas was conducted in patients,the level of necrosis factor alpha （TNF-α）,interleukin-6 （IL-6）,C-reactive protein （CRP） were detected in the time of treatment,in the treatment of 5,10 hours to evaluate the safety and clinical curative effect of the treatment. Results There was no statistical difference of vital signs,biochemical indexes and APACHE lI score after treatment （P〉0.05）;there was no statistical difference of the level of TNF-α,IL-6 and CRP in the time of treatment in the two groups （P〉0.05）,and the level of TNF-α,IL-6 and CRP in the observation group in the treatment of 5,10 hours were significantly lower than those in the control group （P〈0.05）. Conclusion CPFA has a significant effect in reducing inflammatory cytokines level,enhancing the anti-inflammatory/inflammatory factor level and it has the remarkable clinical significance for patients with severe infection complicated with MODS,it is worthy of promotion.