Chu Laping, Li Guangyao, Yu Yafen, Bao Xiaoyan, Wei Hongyi, Hu Minhong
Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi.
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing.
Medicine (Baltimore). 2020 Feb;99(9):e19058. doi: 10.1097/MD.0000000000019058.
Sepsis can cause septic shock, multiple organ dysfunction and even death. The combination of different blood purification would be the certain trend in the treatment of sepsis.This study was to evaluate the clinical effects of hemoperfusion (HP) combined with pulse high volume hemofiltration (PHVHF) on septic shock.Thirty cases were involved in this study and were randomly divided into two groups: HP and PHVHF group (n = 15) and CVVH (continuous veno-venous hemofiltration) group (n = 15). Acute physiology and chronic health evaluation (APACHE) II scores, sequential organ failure assessment (SOFA) scores as well as biochemical changes were measured before and after the treatment. The levels of IL-6, IL-10, and TNF-α in plasma were assessed by ELISA before and after treatment for 2 and 24 h. The norepinephrine doses were also analyzed. The 28-day mortalities in both groups were also compared.In both groups, body temperature (BT), respiratory rate (RR), white blood cells (WBC), C-reactive protein (CRP), Procalcitonin (PCT), lactic acid, serum creatinine, APACHE II scores and SOFA scores decreased after hemofiltration (P < .05). The HP&PHVHF group was superior to the CVVH group in CRP, APACHE II score (P < .01), and heart rate (HR), WBC, PCT, SOFA (P < .05). The doses of norepinephrine were also decreased after treatment (P < .01), with more reduction in the HP&PHVHF group (P < .05). After 24 h of treatment, the levels of IL-6, IL-10, and TNF-α decreased in both groups (P < .05), and the decrease was more significant in HP&PHVHF group (P < .05). In combined group, after 2 h of hemoperfison, there was a significant reduction in these inflammatory factors (P < .01). Combined therapy group's mortality was 26.7%, while CVVH group's was 40%.HP combined with PHVHF has a significant effect on septic shock and can be an important therapy for septic shock.
脓毒症可导致感染性休克、多器官功能障碍甚至死亡。不同血液净化方式的联合应用将是脓毒症治疗的必然趋势。本研究旨在评估血液灌流（HP）联合脉冲高容量血液滤过（PHVHF）治疗感染性休克的临床效果。本研究纳入30例患者，随机分为两组：HP联合PHVHF组（n = 15）和持续静-静脉血液滤过（CVVH）组（n = 15）。分别在治疗前后测量急性生理与慢性健康状况评分系统（APACHE）Ⅱ评分、序贯器官衰竭评估（SOFA）评分以及生化指标变化。在治疗前及治疗后2小时和24小时，采用酶联免疫吸附测定法（ELISA）评估血浆中白细胞介素-6（IL-6）、白细胞介素-10（IL-10）和肿瘤坏死因子-α（TNF-α）的水平。同时分析去甲肾上腺素的用量。比较两组患者的28天死亡率。两组患者血液滤过后体温（BT）、呼吸频率（RR）、白细胞（WBC）、C反应蛋白（CRP）、降钙素原（PCT）、乳酸、血清肌酐、APACHEⅡ评分及SOFA评分均降低（P < 0.05）。HP联合PHVHF组在CRP、APACHEⅡ评分方面优于CVVH组（P < 0.01），在心率（HR）、WBC、PCT、SOFA方面也优于CVVH组（P < 0.05）。治疗后去甲肾上腺素用量也减少（P < 且0.01），HP联合PHVHF组减少更明显（P < 0.05）。治疗24小时后，两组患者IL-6、IL-10及TNF-α水平均降低（P < 0.05），HP联合PHVHF组降低更显著（P < 0.05）。联合治疗组在血液灌流2小时后，这些炎症因子显著降低（P < 0.01）。联合治疗组死亡率为26.7%，而CVVH组为40%。HP联合PHVHF治疗感染性休克效果显著，可成为治疗感染性休克的重要方法。
