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目的研究连续性血液净化(CBP)治疗重症脓毒症患者,对血管内皮损伤的保护作用,及血管内皮损伤与病情演变之间的关系。方法17例重症脓毒症患者接受连续性血液净化(CBP)治疗共25次,观察患者接受CBP治疗前、治疗结束后次日血管性假性血友病因子(vWF)、凝血象、血常规及生化指标等变化;根据患者接受CBP治疗前和治疗后采集血标本时间不同,分为治疗前组和治疗后组;根据患者的预后分为存活组和死亡组。结果CBP治疗后组vWF较治疗前组显著降低(P<0.05),治疗后组APACHEⅡ和MODS评分也较治疗前组明显降低(P<0.05);CBP治疗前组,vWF与血白细胞计数(WBC)及血小板计数(PLT)呈正相关(P<0.01),与氧合指数呈负相关(P<0.05);CBP治疗后组,vWF与WBC和D-二聚体均呈正相关(P<0.01,0.05)。CBP治疗后存活组患者,vWF仅仅与血WBC呈正相关(P<0.01);而CBP治疗后死亡组患者,vWF与总脱水量及红细胞比积呈正相关(P<0.01),而与PT-INR和APTT呈负相关(P<0.01,P<0.05)。结论CBP治疗对重症脓毒症患者血管内皮损伤起到保护作用;在CBP治疗过程中,脱水过多,又可能加重血管内皮损伤。
Objective To investigate the protective effect of continuous blood purification (CBP) on patients with severe sepsis and the relationship between vascular endothelial injury and the progression of the disease. Methods Seventeen patients with severe sepsis underwent continuous blood purification (CBP) for 25 times. Before treatment with CBP, vWF, coagulation, blood routine And biochemical indicators such as changes; according to patients receiving CBP before and after treatment blood samples collected at different times, divided into pre-treatment group and post-treatment group; according to the prognosis of patients were divided into survival group and death group. Results Compared with pretreatment group, the vWF of CBP group was significantly lower (P <0.05), APACHE Ⅱ and MODS score of the group after treatment were also significantly lower than those before treatment (P <0.05); vWF and WBC ) And platelet count (PLT) (P <0.01), but negatively correlated with oxygenation index (P <0.05). After CBP treatment, vWF was positively correlated with WBC and D-dimer 0.05). VWF was positively correlated only with blood WBC (P <0.01). In CBP-treated group, vWF was positively correlated with total dehydration and hematocrit (P <0.01), but not with PT-INR And APTT was negatively correlated (P <0.01, P <0.05). Conclusion CBP can protect vascular endothelial cells of patients with severe sepsis. In the process of CBP, excessive dehydration may aggravate vascular endothelial injury.