连续性血液净化治疗尿脓毒血症导致多器官功能障碍综合征12例临床分析

Continuous blood purification in the treatment of multiple organ dysfunction syndrome induced by urinary sepsis:clinical analysis of 12 cases

摘要:

目的：观察连续性血液净化（Continuous blood purification，CBP）在救治尿脓毒血症所致多器官功能障碍综合征（Multiple organ dysfunction syndrome，MODS）患者的临床疗效及对细胞因子的影响，探讨其治疗效果。方法：12例行持续静脉－静脉血液滤过（Continuous venous-venous hemofihration，CVVH）的尿脓毒血症所致MODS患者为研究对象，比较其治疗前、后生命体征，急性生理和慢性健康评分系统评分，白细胞，氧分压，肝、肾功能和细胞因子肿瘤坏死因子(Tumor necrosis factor-α,TNF-α)、白细胞介素1(Interleulcin-1,IL-1)、白细胞介素8(Interleulcin-8,IL-8)水平的变化。结果:CVVH治疗后的尿脓毒血症所致MODS患者其临床指标与治疗前比较明显改善，细胞因子TNF-α、IL-1、IL-8的水平与治疗前比较明显降低，差异有统计学意义(P<0．05)。结论:CVVH能改善尿脓毒血症所致MODS患者的临床指标，降低患者细胞因子水平，可在一定程度上改善尿脓毒血症所致MODS患者的预后。

Abstract:

Objective:To observe the clinical efficacy of continuous blood purification(CBP) for multiple organ dysfunction syndrome(MODS) induced by urinary sepsis and to discuss its effect on cytokines.Methods:Totally 12 patients with MODS induced by urinary sepsis were treated by continuous venous-venous hemofiltration(CVVH).Vital signs,acute physiology and chronic health evaluation system scores,white blood cell,oxygen partial pressure,liver and kidney functions and levels of cytokines such as TNF-α,IL-1 and IL-8 were measured and compared before and after the treatment.Results:The clinical indicators of patients with MODS were improved significantly after CVVH treatment compared with those before the treatment.The plasma concentrations of TNF-α,IL-1,IL-8 were decreased obviously compared with those before the treatment (P<0.05).Conclusion:CVVH can improve the clinical indicators of MODS induced by urinary sepsis,decrease the cytokines level and to some extent promote the patients’ prognosis.