【摘要】 目的 观察早期血液灌流（HP）救治脓毒症患者的临床疗效。方法 选择2020年1月至2022年12月河南大学附属南阳市第一人民医院收治的脓毒症早期患者作为研究对象。将患者按随机原则分为试验组（62例）和对照组（31例）。两组均给予早期集束化治疗并行连续性肾脏替代治疗（CRRT）的标准治疗，对照组仅采用标准治疗，试验组在对照组基础上给予HP，采用“2-2-1”方案（治疗1 d、2 d，每12 h串联HA380树脂血液灌流器，治疗3 d串联1个灌流器）。比较两组患者治疗前和治疗3 d后白细胞计数（WBC）、C-反应蛋白（CRP）、降钙素原（PCT）、肿瘤坏死因子-α(TNF-α)、白细胞介素（IL-6、IL-10），以及血流动力学指标（收缩压、舒张压）、血乳酸（Lac）、序贯器官衰竭评分（SOFA）、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、重症监护病病房（ICU）住院时间的差异；采用Kaplan-Meier法绘制生存曲线，比较两组28 d生存率的差异。结果 治疗3 d后，试验组炎症指标TNF-α、IL-6、IL-10、PCT、CRP、WBC及SOFA评分、APACHEⅡ评分、Lac均较治疗前明显下降，对照组仅PCT、CRP较治疗前明显下降（均P<0.05）。与对照组比较，试验组PCT、CRP、IL-6、IL-10水平及SOFA评分、APACHEⅡ评分、Lac治疗前后变化的差值明显升高[PCT（μg/L）:12.31(6.95,42.69)比3.84(1.06,14.47),CRP(mg/L):78.69±64.60比31.49±81.14,IL-6(ng/L):1 357.20(243.96,7 205.50)比110.00(-1 749.00,1 377.00),IL-10(ng/L):36.87(5.43,1 218.80)比2.67(-11.00,22.79),SOFA评分（分）：5(3,7)比1(-3,6),APACHEⅡ评分（分）：8(5,11)比5(-2,7),Lac(mmol/L):3.93±2.89比2.42±2.89，均P<0.05]；试验组炎症细胞因子IL-6、IL-10清除率明显高于对照组[IL-6:F=17.930,P<0.001;IL-10:F=6.620,P=0.012]。Kaplan-Meier生存曲线分析显示，试验组28 d累积生存率明显高于对照组（79.03%比58.06%），差异均有统计学意义（Log-Rank检验：χ~2=4.706,P=0.030）。多因素Cox回归分析显示：未进行HP治疗、治疗前Lac水平、高APACHEⅡ评分是影响患者死亡的危险因素。结论 HP在脓毒症早期介入治疗可降低患者炎症指标水平，控制炎症风暴，HP“2-2-1”的治疗频次可有效改善患者预后，提高患者生存率。更多还原

【Abstract】 Objective To investigate the curative effect of early hemoperfusion(HP) in treating patients with sepsis. Methods Early stage sepsis patients admitted to the First People’s Hospital of Nanyang City Affiliated to Henan University from January 2020 to December 2022 were selected as the research subjects. These patients were randomly divided into experimental group(62 patients) and control group(31 patients). Early bundle therapy combined with continuous renal replacement therapy(CRRT) were used in both groups as the standard treatment, but only the standard treatment was used in control group. Based on the treatment of control group, the patients in experimental group were treated with HP, the "2-2-1" plan(on the first and second days, connecting resin HP device HA380 in series every 12 hours, and connecting one perfusion device in series on the third day) was applied. The white blood cell count(WBC), C-reactive protein(CRP), procalcitonin(PCT), tumor necrosis factor-α(TNF-α), interleukins(IL-6, IL-10),the hemodynamic indicators(systolic blood pressure, diastolic blood pressure), lactic acid(Lac), sequential organ failure assessment(SOFA), acute physiology and chronic health evaluationⅡ(APACHEⅡ), and the difference in intensive care unit(ICU) hospitalization time of the patients before admission and after 3 day treatment were compared between the two groups. The Kaplan-Meier method was used to draw survival curves and the difference in 28-day survival rates was compared between the two groups. Results After 3 days of treatment, the inflammatory indexes TNF-α, IL-6, IL-10,PCT, CRP, WBC and SOFA score, APACHEⅡscore, Lac in the experimental group all decreased significantly(all P <0.05). In the control group, only the PCT and CRP indexes significantly decreased compared with those before treatment(both P < 0.05). Compared with the control group, the difference before and after the change of PCT, CRP, IL-6, IL-10and SOFA score, APACHEⅡscore, Lac in the experimental group were significant [PCT(μg/L): 12.31(6.95, 42.69) vs.3.84(1.06, 14.47), CRP(mg/L): 78.69±64.60 vs. 31.49±81.14, IL-6(ng/L): 1 357.20(243.96, 7 205.50) vs. 110.00(-1 749.00, 1 377.00), IL-10(ng/L): 36.87(5.43, 1 218.80) vs. 2.67(-11.00, 22.79), SOFA score: 5(3, 7) vs. 1(-3, 6),APACHEⅡscore: 8(5, 11) vs. 5(-2, 7), Lac(mmol/L): 3.93±2.89 vs. 2.42±2.89, all P < 0.05]. The clearance rate of inflammatory cytokines IL-6 and IL-10 in the experimental group was higher than that in the control group(IL-6: F =17.93, P < 0.001, IL-10: F = 6.62, P = 0.012). The Kaplan-Meier curve showed the 28-day survival rate of the experimental group was higher than that of the control group(79.03% vs. 58.06%), the differences were statistically significant(Log-Rank test: χ~2 = 4.706, P = 0.030). Multivariate Cox regression analysis showed that no HP treatment,Lac level before treatment and high APACHEⅡ score were risk factors for death Conclusion HP in the early interventional treatment of sepsis can reduce the levels of inflammatory cytokines and control the inflammatory storm. The HP "2-2-1" treatment frequency can effectively improve the prognosis of septic patients and increase their survival rate.更多还原