間斷性血液灌流和連續性血液濾過治療膿毒癥的療效比較_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 頡永樂 ¹ ,  劉健 ² , 杜毅君 ¹ , 蘇文濤 ¹ , 卿楠 ¹ , 辛宏偉 ¹

1. ;
2. ;

Corresponding?author：

劉健, Email: medecinliu@sina.com

Keywords：

血液灌流; 血液濾過; 膿毒癥; 炎癥介質

DOI：

10.7507/1007-9424.20150225

Video：

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目的探討血液灌流（hemoperfusion，HP）和連續性靜脈-靜脈血液濾過（continuous veno-venous hemofiltration，CVVH）治療膿毒癥患者的臨床療效。方法采用隨機對照研究方法，將天水市第一人民醫院重癥監護病房（ICU）2012～2014年期間收治的67例革蘭陰性膿毒癥患者按抽簽法隨機分為常規治療組（24例）、HP治療組（18例）及CVVH治療組（25例）3組，觀察3組患者治療前和治療后24、48及72 h的心率（HR）、平均動脈壓（MAP）、APACHEⅡ評分、降鈣素原（PCT）、C反應蛋白（CRP）和血清內毒素（ET）水平的變化。結果治療后24、48及72 h CVVH治療組的各項指標改善均較常規治療組和HP治療組明顯（P<0.05）；HP治療組僅在治療后24 h各項指標相較于常規治療組下降（P<0.05），但在治療后48及72 h時與常規治療組相比差異無統計學意義（P>0.05）。結論 HP和CVVH都能不同程度地降低炎癥介質，但以CVVH治療的效果更明顯；膿毒癥的轉歸可能有更多的影響因素。

Citation： 頡永樂, 劉健, 杜毅君, 蘇文濤, 卿楠, 辛宏偉. 間斷性血液灌流和連續性血液濾過治療膿毒癥的療效比較. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(7): 863-866. doi: 10.7507/1007-9424.20150225 Copy

1.	?Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med, 2013, 39(2):165-228.
2.	Ronco C, Tetta C, Mariano F, et al. Interpreting the mechanisms of continuous renal replacement therapy in sepsis:the peakconcentration hypothesis. Artif Organs, 2003, 27(9):792-801.
3.	季大璽, 龔德華, 劉斌. 連續性血液凈化在重癥監護病房中的應用. 中華醫學雜志, 2002, 82(18):1291-1294.
4.	Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure:a prospective randomized trial. Lancet, 2000, 356 (9223):26-30.
5.	Honore PM, Jamez J, Wauthier M, et al. Prospective evaluation of short-term, high-volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock. Crit Care Med, 2000, 28(11):3581-3587.
6.	Tsuchida K, Yoshimura R, Nakatani T, et al. Blood purification for critical illness:cytokines adsorption therapy. Ther Apher Dial, 2006, 10(1):25-31.
7.	Kunitomo T, Shoji HT, Pirenne B, et al. Endotoxin removal by toraymixin. Contrib Nephrol, 2001, 132:415-420.
8.	Hussein MH, Kato T, Sugiura T, et al. Effect of hemoperfusion using polymyxin B-immobilized fiber on IL-6, HMGB-1, and IFN gamma in a neonatal sepsis model. Pediatr Res, 2005, 58(2):309-314.
9.	Ruberto F, Pugliese F, D'Alio A, et al. Clinical effects of direct hemoperfusion using a polymyxin-B immobilized column in solid organ transplanted patients with signs of severe sepsis and septic shock. A pilot study. Int J Artif Organs, 2007, 30(10):915-922.
10.	Cruz DN, Bellomo R, Ronco C. Clinical effects of polymyxin B-immobilized fiber column in septic patients. Contrib Nephrol, 2007, 156:444-451.
11.	黃昭, 王思榮, 劉繼云. 血液灌流治療對膿毒癥急性腎損傷患者炎癥因子的清除及腎臟保護作用. 中華急診醫學雜志, 2011, 20(1):60-64.
12.	杜斌, 陳德昌, 潘家綺, 等. 降鈣素原與白介素-6的相關性優于傳統的炎癥指標. 中國危重病急救醫學, 2002, 14(8):474-477.
13.	陳煒, 趙磊, 牛素平, 等. 不同炎癥因子對細菌性血流感染所致膿毒癥患者的早期診斷價值. 中國危重病急救醫學, 2014, 26(3):165-170.
14.	陳煒, 李麗娟, 古旭云, 等. 動態監測外周血降鈣素原水平對膿毒性休克患者預后的預測價值. 中國危重病急救醫學, 2012, 24(8):470-473.
15.	Póvoa P, Almeida E, Moreira P, et al. C-reactive Protein as an indicator of sepsis. Intensive Care Med, 1998, 24(10):1052-1056.
16.	Lannerg?rd A, Larsson A, Friman G, et al. Human serum amyloid A (SAA) and high sensitive C-reactive protein (hsCRP) in preterm newborn infants with nosocomial infections. Acta Paediatr, 2008, 97(8):1061-1065.
17.	趙世峰, 沈洪. 內毒素血癥早期治療的基礎研究. 世界急危重病醫學雜志, 2007, 4(3):1884-1888.
18.	Nakamura T, Kawagoe Y, Suzuki T, et al. Polymyxin B-immobilized fiber hemoperfusion with the PMX-05R column in elderly patients suffering from septic shock. Am J Med Sci, 2007, 334(4):244-247.
19.	Kushi H, Miki T, Okamaoto K, et al. Early hemoperfusion with an immobilized polymyxin B fiber column eliminates humoral mediators and improves pulmonary oxygenation. Crit Care, 2005, 9(6):R653-R661.
20.	Tsushima K, Kubo K, Yoshikawa S, et al. Effects of PMX-DHP treatment for patients with directly induced acute respiratory distress syndrome. Ther Apher Dial, 2007, 11(2):138-145.
21.	Dahaba AA, EI-Awady GA, Rehak PH, et al. Procalcitonin and proinflammatory cytokine clearance during continuous venovenous haemofiltration in septic patients. Anaesth Intensive Care, 2002, 30(3):269-274.

1. ?Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med, 2013, 39(2):165-228.
2. Ronco C, Tetta C, Mariano F, et al. Interpreting the mechanisms of continuous renal replacement therapy in sepsis:the peakconcentration hypothesis. Artif Organs, 2003, 27(9):792-801.
3. 季大璽, 龔德華, 劉斌. 連續性血液凈化在重癥監護病房中的應用. 中華醫學雜志, 2002, 82(18):1291-1294.
4. Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure:a prospective randomized trial. Lancet, 2000, 356 (9223):26-30.
5. Honore PM, Jamez J, Wauthier M, et al. Prospective evaluation of short-term, high-volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock. Crit Care Med, 2000, 28(11):3581-3587.
6. Tsuchida K, Yoshimura R, Nakatani T, et al. Blood purification for critical illness:cytokines adsorption therapy. Ther Apher Dial, 2006, 10(1):25-31.
7. Kunitomo T, Shoji HT, Pirenne B, et al. Endotoxin removal by toraymixin. Contrib Nephrol, 2001, 132:415-420.
8. Hussein MH, Kato T, Sugiura T, et al. Effect of hemoperfusion using polymyxin B-immobilized fiber on IL-6, HMGB-1, and IFN gamma in a neonatal sepsis model. Pediatr Res, 2005, 58(2):309-314.
9. Ruberto F, Pugliese F, D'Alio A, et al. Clinical effects of direct hemoperfusion using a polymyxin-B immobilized column in solid organ transplanted patients with signs of severe sepsis and septic shock. A pilot study. Int J Artif Organs, 2007, 30(10):915-922.
10. Cruz DN, Bellomo R, Ronco C. Clinical effects of polymyxin B-immobilized fiber column in septic patients. Contrib Nephrol, 2007, 156:444-451.
11. 黃昭, 王思榮, 劉繼云. 血液灌流治療對膿毒癥急性腎損傷患者炎癥因子的清除及腎臟保護作用. 中華急診醫學雜志, 2011, 20(1):60-64.
12. 杜斌, 陳德昌, 潘家綺, 等. 降鈣素原與白介素-6的相關性優于傳統的炎癥指標. 中國危重病急救醫學, 2002, 14(8):474-477.
13. 陳煒, 趙磊, 牛素平, 等. 不同炎癥因子對細菌性血流感染所致膿毒癥患者的早期診斷價值. 中國危重病急救醫學, 2014, 26(3):165-170.
14. 陳煒, 李麗娟, 古旭云, 等. 動態監測外周血降鈣素原水平對膿毒性休克患者預后的預測價值. 中國危重病急救醫學, 2012, 24(8):470-473.
15. Póvoa P, Almeida E, Moreira P, et al. C-reactive Protein as an indicator of sepsis. Intensive Care Med, 1998, 24(10):1052-1056.
16. Lannerg?rd A, Larsson A, Friman G, et al. Human serum amyloid A (SAA) and high sensitive C-reactive protein (hsCRP) in preterm newborn infants with nosocomial infections. Acta Paediatr, 2008, 97(8):1061-1065.
17. 趙世峰, 沈洪. 內毒素血癥早期治療的基礎研究. 世界急危重病醫學雜志, 2007, 4(3):1884-1888.
18. Nakamura T, Kawagoe Y, Suzuki T, et al. Polymyxin B-immobilized fiber hemoperfusion with the PMX-05R column in elderly patients suffering from septic shock. Am J Med Sci, 2007, 334(4):244-247.
19. Kushi H, Miki T, Okamaoto K, et al. Early hemoperfusion with an immobilized polymyxin B fiber column eliminates humoral mediators and improves pulmonary oxygenation. Crit Care, 2005, 9(6):R653-R661.
20. Tsushima K, Kubo K, Yoshikawa S, et al. Effects of PMX-DHP treatment for patients with directly induced acute respiratory distress syndrome. Ther Apher Dial, 2007, 11(2):138-145.
21. Dahaba AA, EI-Awady GA, Rehak PH, et al. Procalcitonin and proinflammatory cytokine clearance during continuous venovenous haemofiltration in septic patients. Anaesth Intensive Care, 2002, 30(3):269-274.

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間斷性血液灌流和連續性血液濾過治療膿毒癥的療效比較

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