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目的研究严重烧伤早期应用间歇性血液滤过(IHF)联合血液灌注流(HP)防治脓毒症的临床效果。方法选取2013年3月至2015年12月于惠州市中心人民医院入院治疗的烧伤患者50例,随机分为研究组(n=25)及对照组(n=25)。对照组按常规方法进行治疗,研究组在此基础进行IHF+HP治疗(伤后4、6、8、11 d)。记录两组患者伤后4、6、8、11、15 d的体温(BT)、心率(HR)和呼吸频率(BPM);白细胞数量(WBC)、中性粒细胞(NEUT)、尿素氮(BUN);白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)及高迁移率簇蛋白-1(HMGB-1);LPS和PCT。结果研究组伤后4、6、8、11、15 d的HR、WBC、BUN、IL-1、TNF-α、HMGBI、LPS和LCT均低于对照组,差异有统计学意义(P<0.05);研究组除伤后4 d外,其余天数BPM均明显低于对照组,差异有统计学意义(P<0.05);研究组除伤后6 d外,其余天数BT明显低于对照组,差异有统计学意义(P<0.05);研究组除伤后8 d外,其余天数IL-6均低于对照组,差异有统计学意义(P<0.05)。结论 IHF+HP的治疗方案对严重烧伤患者是可行有效的,能够防治脓毒症的发生。
Objective To study the clinical effect of intermittent hemofiltration (IHF) and hemoperfusion (HP) on the prevention and treatment of sepsis in the early stage of severe burn. Methods From March 2013 to December 2015, 50 patients admitted to Huizhou Central People’s Hospital were randomly divided into study group (n = 25) and control group (n = 25). The control group was treated by conventional methods. The study group was treated with IHF + HP on the basis of this (4, 6, 8 and 11 days after injury). The body temperature (BT), heart rate (HR) and respiratory rate (BPM) were recorded at 4, 6, 8, 11 and 15 days after injury in the two groups; the number of white blood cells (WBC), neutrophils BUN), interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor α (TNF- α) and high-migration clusterin- PCT. Results The HR, WBC, BUN, IL-1, TNF-α, HMGBI, LPS and LCT of the study group were significantly lower than those of the control group on the 4th, 6th, 8th, ). The BPM of the other days except the 4 days after injury in the study group was significantly lower than that in the control group (P <0.05). The BT of other days in the study group was significantly lower than that of the control group 6 days after injury, The difference was statistically significant (P <0.05). In the study group, except for the 8th day after injury, the other days IL-6 were lower than the control group, the difference was statistically significant (P <0.05). Conclusion The treatment of IHF + HP is feasible and effective for patients with severe burns and can prevent and treat sepsis.