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目的:探讨脓毒症休克患者早期应用血液净化治疗,对其炎性指标及细胞免疫功能的影响。方法:将130例确诊脓毒症休克患者随机分为血滤组与常规组,每组各65例。血滤组在综合治疗基础上给予连续性肾脏替代治疗(CRRT),持续治疗72h。监测两组患者入院时及第3、7天血清C反应蛋白水平,淋巴细胞亚群CD3~+、CD4~+、CD8~+、CD4~+/CD8~+水平,治疗前后急性生理学与慢性健康状况(APACHEⅡ)评分。结果:两组患者治疗后C反应蛋白均较治疗前降低,治疗后血滤组各时点数据低于常规组,两组比较差异有统计学意义(P<0.01)。治疗后两组患者外周血T淋巴细胞亚群水平(CD3~+、CD4~+、CD4~+/CD8~+)均较治疗前明显升高,比较差异均有统计学意义(P<0.05);治疗后血滤组各时点数据较常规组患者升高更明显,比较差异均有统计学意义(P<0.01)。两组患者治疗后APACHEⅡ评分均较治疗前降低,治疗后血滤组数据低于常规组,比较差异均有统计学意义(P<0.01)。结论:脓毒症休克患者早期应用连续性血液净化治疗,可以显著抑制全身炎症反应,改善患者的细胞免疫功能,提高患者疗效。
Objective: To investigate the effect of early blood purification treatment on the inflammatory index and cellular immune function in septic shock patients. Methods: 130 patients with confirmed septic shock were randomly divided into routine treatment group and control group, 65 cases in each group. The blood filter group was given continuous renal replacement therapy (CRRT) on the basis of comprehensive treatment for 72 hours. The levels of serum C-reactive protein, CD3 +, CD4 +, CD8 +, CD4 + / CD8 + in lymphocyte subsets at admission and on days 3 and 7 of both groups were monitored. Before and after treatment, acute physiology and chronic health Condition (APACHE II) score. Results: After treatment, the C-reactive protein in both groups was lower than before treatment. After treatment, the data of the blood-filter group at each time point were lower than those in the conventional group. There was significant difference between the two groups (P <0.01). The levels of peripheral blood T lymphocyte subsets (CD3 ~ +, CD4 ~ +, CD4 ~ + / CD8 ~ +) in the two groups after treatment were significantly higher than those before treatment (all P0.05) After treatment, the data of blood-filter group at each time point increased more significantly than those in the conventional group, and the difference was statistically significant (P <0.01). The APACHEⅡscores of both groups were lower than before treatment, and the data of the blood filter group after treatment were lower than those of the conventional group (P <0.01). Conclusion: The early application of continuous blood purification in patients with septic shock can significantly inhibit the systemic inflammatory response, improve the patient’s cellular immune function and improve the efficacy of the patients.