早期CVVH治疗坏死性筋膜炎并发脓毒性休克的临床研究

发布时间：2018-01-27 03:40

本文关键词： 坏死性筋膜炎 CVVH 脓毒性休克炎症介质　出处：《免疫学杂志》2016年02期 　论文类型：期刊论文

【摘要】：目的评价早期持续静-静脉血液滤过(CVVH)在坏死性筋膜炎(NF)并发脓毒性休克中的治疗效果。方法回顾性研究坏死性筋膜炎并发脓毒性休克患者实施CVVH治疗33例,其中早期(24 h内)实施CVVH治疗15例(试验组),晚期实施CVVH治疗13例(对照组),比较2组患者2、4、6 d体内炎症指标CRP、TNF-α、IL-1、IL-6、IL-10,免疫指标淋巴细胞CD4/CD8,血流动力学指标ELWI、LAC,平均氧合指数(OI)、平均机械通气时间(MVT)、平均ICU住院日(ALST)及死亡率。结果试验组IL-1、IL-6、IL-10、ELWI、LAC水平均明显低于相应时间对照组水平,OI明显高于对照组(P0.05);CD4/CD8值、CRP及TNF-α水平无统计学差异性(P0.05);MVT、ALST及死亡率均明显低于对照组,有统计学意义(P0.05)。结论 NF并发脓毒性休克早期实施CVVH治疗可降低炎性介质水平,重塑炎症与抑炎平衡,降低ELWI,改善氧合指数,缩短MVT、ALST及降低死亡率。
[Abstract]:Objective to evaluate the role of CVVH in the diagnosis of necrotizing fasciitis in patients with early persistent veno-venous hemofiltration (CVVH). Methods 33 patients with necrotizing fasciitis complicated with septic shock were treated with CVVH. 15 cases (test group) were treated with CVVH within 24 h (experimental group) and 13 cases (control group) were treated with CVVH (control group). The inflammation index CRP was compared between two groups after 6 days. TNF- 伪, IL-1, IL-6, IL-10, lymphocyte CD4 / CD8, hemodynamic index ELWILAC, mean oxygenation index (Oi). The mean time of mechanical ventilation and the average duration of ICU in hospital were measured, and the mortality was also observed. Results in the test group, IL-6 / IL-10 / ELWI was found. The level of LAC in the control group was significantly lower than that in the control group (P 0.05). The levels of CD4/CD8 and TNF- 伪 were not significantly different (P 0.05). MVTT ALST and mortality were significantly lower than those in the control group (P 0.05). Conclusion CVVH therapy in the early stage of NF complicated with septic shock can reduce the level of inflammatory mediators. Reconstructing the balance between inflammation and anti-inflammation, reducing ELWI, improving oxygenation index, shortening MVTT ALST and reducing mortality.
【作者单位】：重庆医科大学附属第一医院急诊&重症医学科;重庆医科大学附属第一医院肿瘤科;重庆医科大学附属第一医院肝胆外科;重庆医科大学附属第二医院肝胆外科;
【基金】：%E5%BB%BA%E8%AE%BE%E9%A1%B9%E7%9B%AE" target="_blank">国家卫计委<国家临床重点专科—重症医学科>建设项目国家自然科学基金(81401622,81301656)
【分类号】：R459.7;R686.3
【正文快照】： 坏死性筋膜炎(necrotizing fascilitis,NF)是一种罕见、致命的软组织感染,它以皮下组织和深浅筋膜坏死为特征,起病急、进展快、破坏性极强,因此常出现严重脓毒血症、脓毒性休克、多器官功能衰竭[1]。由于该病早期缺乏特异性的临床表现,与许多其他软组织疾病如蜂窝组织炎很相似

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