吕世进　于欢　魏霞

[摘要] 目的 研究在綜合治疗的基础脏器上早期连续性静脉-静脉血液滤过治疗感染患者，对于炎症介质清除及功能保护，为临床感染疾病更好的治疗提供依据。 方法 回顾性分析诊断为感染的患者115例，所有患者均经过连续性血液滤过治疗，比较治疗前后血炎症介质、降钙素原（procalcitonin，PCT）、C反应蛋白、白介素1、白介素6、白介素10、肿瘤坏死因子、血红蛋白、血小板含量的变化，肝肾功能及乳酸的变化。 结果 患者经首次连续静脉-静脉血液滤过治疗24 h后，炎症指标 C反应蛋白（CRP）、血小板（Plt）明显下降，差异有统计学意义（P<0.05）。降钙素原（PCT）、血红蛋白（Hb）也有下降，差异无统计学意义（P>0.05）。APACHE-Ⅱ及 MODS 评分下降，差异有统计学意义（P<0.05）。经滤过治疗48 h后，各项指标均有明显降低（P<0.05），尿素氮含量也有减少，差异无统计学意义（P>0.05）。治疗前后血炎症因子血IL-1，IL-6，IL-10，TNF-α比较，治疗24 h后较治疗前指标下降，差异有统计学意义（P<0.05），48 h后较治疗前有明显下降，差异有统计学意义（P<0.01）。 结论 通过连续性静脉-静脉血液滤过治疗可清除炎症介质，减轻炎症反应，减少器官功能损害，降低病死率，但有破坏血液成分的并发症。

[关键词] 连续性静脉-静脉血液滤过；多器官功能障碍综合征；炎症因子；脓毒症；血液成份

[中图分类号] R657.51 [文献标识码] B [文章编号] 1673-9701（2017）19-0079-04

[Abstract] Objective To study the effect of early continuous veno-venous hemofiltration therapy on the basis of comprehensive treatment in the treatment of inflammatory media removal and functional protection， and to provide a basis for the better treatment of clinical infection. Methods A total of 115 patients diagnosed with infection were retrospectively analyzed， and all patients were subjected to continuous hemofiltration therapy.The changes of blood inflammatory mediators， proccalcitonin（PCT）， C-reactive protein， interleukin 1， interleukin 6， interleukin 10， tumor necrosis factor， hemoglobin and platelet content， and the changes of liver and kidney function and lactic acid between before and after treatment were compared. Results The inflammation index C-reactive protein （CRP） and platelet （Plt） significantly decreased after 24 hours of continuous veno-venous hemofiltration at the first time（P<0.05）， and the difference was statistically significant. Calcitonin （PCT） and hemoglobin （Hb） also decreased ， and the difference was not statistically significant（P>0.05）. APACHE-Ⅱand MODS scores decreased， with statistically significant difference（P<0.05）. After 48 hours of filtration treatment， the indexes significantly decreased（P<0.05）， and the content of urea nitrogen also decreased，with no statistically significant difference（P>0.05）. The blood inflammatory factors including serum IL-1， IL-6， IL-10 and TNF-α were measured before and after treatment，the indicators after 24 hours of treatment were lower than before treatment，with statistically significant differences（P<0.05）； and the indicators after 48 hours of treatment were lower than before treatment， with highly statistically significant differences（P<0.01）. Conclusion Continuous veno-venous hemofiltration treatment can clear the inflammatory mediators， and can reduce the inflammatory reaction， organ function damage and the mortality， but it has a complication of damaging blood components.

[Key words] Continuous veno-venous hemofiltration； Multiple organ dysfunction syndrome； Inflammatory factor； Sepsis； Blood component

EICU收住患者往往病情危重，生命体征不稳定，感染是监护病房常见病、并发症，或者是其他疾病的合并症。致病菌种类繁杂、毒力强，而且大部分患者抵抗力差，疾病发病急，进展较快。临床上感染严重的患者除原发病器官本身功能损害，常同时合并有其他器官功能损害，致病细菌以及其产生的毒素可从原发局部感染部位短时间内扩散进入血液循环，逐渐进入全身系统，进而引起全身感染及各脏器受损的临床症状[1]。感染严重的患者各系统损害往往较重，如果在早期能及时采取有效治疗措施可明显降低患者的病死率，否则可能进一步发展成为脓毒症休克、多器官功能障碍综合征（MODS）等严重并发症[2，3]。……