目的:探究连续性血液净化(Continuous blood purification,CBP)对脓毒症患者凝血功能及免疫功能的影响。方法:选取2012年1月至2015年1月入住新疆兵团第一师医院重症监护病房54例符合脓毒症诊断标准的患者纳入本研究。采取CBP治疗,分别在治疗前、治疗后12、24、48、72 h时,对患者持续性观察,测定其APACHEⅡ评分。收集患者不同CBP治疗时间段的血液,利用流式细胞仪检测外周血免疫细胞CD4~+/CD8~+,ELISA法检测其分泌的细胞因子IL-1、IL-6、IL-10和TNF-α,凝固法检测其凝血功能指标PT、APTT、TT,免疫比浊法检测FIB。结果:脓毒症患者治疗前PT、APTT、TT和FIB含量高于健康人群,具有统计学意义(均P<0.05)。CBP治疗12、24、48、72h的凝血功能指标PT、APTT、TT、FIB相比CBP治疗前显著降低(P<0.05)。脓毒症患者组的CD3~+、CD4~+和CD4~+/CD8~+细胞频率较健康组明显降低(均P<0.05)。CBP治疗12、24、48、72h,相比治疗前,CD3~+T、CD4~+T细胞频率逐渐升高(均P<0.05)。CBP治疗12、24、48、72h的CD4~+/CD8~+比例比治疗前显著升高(均P<0.05)。治疗前、CBP治疗12、24、48h的CD3~+、CD4~+及CD4~+/CD8~+细胞频率低于健康组(均P<0.05)。CBP治疗12、24、48、72h的IL-1、IL-6、IL-10的水平较治疗前降低(均P<0.05)。CBP治疗48h、72h的TNF-α的水平较治疗前显著降低(均P<0.05)。治疗前、CBP治疗12、24、48h的IL-1的水平高于健康组(均P<0.05)。治疗前、CBP治疗12、24、48、72h的IL-6、IL-10的水平高于健康组(均P<0.05)。治疗前、CBP治疗12、24h的TNF-α水平显著高于健康组(均P<0.05)。CBP治疗12、24、48、72 h的APACHEⅡ评分与治疗前比较均显著降低(均P<0.05)。结论:连续性血液净化能够通过清除血液中炎症因子,增强机体免疫功能,对改善脓血症患者的病情有一定帮助。 Objective: To investigate the effects of continuous blood purification (CBP) on coagulation and immune function in septic patients. Methods: From January 2012 to January 2015 in Xinjiang Corps First Division hospital intensive care unit 54 cases of patients with sepsis diagnostic criteria included in this study. Take CBP treatment, respectively, before treatment, 12,24,48,72 h after treatment, the patients were observed continuously, the APACHE Ⅱ score was measured. Blood samples were collected from different CBP treatment groups. CD4 ~ + / CD8 ~ + levels of peripheral blood immune cells were detected by flow cytometry. The levels of IL-1, IL-6, IL-10 and TNF- α, coagulation method to detect coagulation function index PT, APTT, TT, immune turbidimetry test FIB. Results: The levels of PT, APTT, TT and FIB in patients with sepsis before treatment were significantly higher than those in healthy people (all P <0.05). The indexes of coagulation function of PT, APTT, TT and FIB of CBP group at 12, 24, 48 and 72h were significantly lower than those before CBP treatment (P <0.05). The frequency of CD3 ~ +, CD4 ~ + and CD4 ~ + / CD8 ~ + cells in sepsis group was significantly lower than that in healthy group (all P <0.05). CBP treatment for 12,24,48,72h, compared with before treatment, CD3 ~ + T, CD4 ~ + T cell frequency increased (all P <0.05). The proportion of CD4 ~ + / CD8 ~ + in CBP group at 12, 24, 48 and 72h was significantly higher than that before treatment (all P <0.05). Before treatment, the frequencies of CD3 ~ +, CD4 ~ + and CD4 ~ + / CD8 ~ + cells in CBP group were lower than those in healthy group at 12, 24 and 48h (all P <0.05). The levels of IL-1, IL-6 and IL-10 at 12, 24, 48 and 72h after CBP treatment were lower than those before treatment (all P <0.05). The levels of TNF-α in CBP treated for 48h and 72h were significantly lower than those before treatment (all P <0.05). Before treatment, the levels of IL-1 at 12, 24 and 48h after CBP treatment were higher than those in healthy group (all P <0.05). Before treatment, the levels of IL-6 and IL-10 at 12, 24, 48 and 72h after CBP treatment were higher than those in healthy group (all P <0.05). Before treatment, the level of TNF-αin CBP group was significantly higher than that in healthy group at 12 and 24 hours (all P <0.05). The APACHEⅡscores of CBP treated for 12, 24, 48 and 72 h were significantly lower than those before treatment (all P <0.05). CONCLUSION: Continuous blood purification can help to improve the condition of patients with sepsis by clearing the inflammatory factors in the blood and enhancing the body’s immune function.