摘要目的 评价分子吸附再循环系统(MARS)对重症肺炎合并多器官功能障碍综合征(MODS)的治疗效果.方法 将75例重症肺炎合并MODS的患者随机分为MARS治疗组、连续性肾脏替代治疗(CRRT)组和常规综合治疗组,观察并比较组间血流动力学、呼吸功能、肝肾功能、凝血功能、炎性介质以及Marshall评分等指标在治疗前后的变化,同时比较3组患者60 d内生存曲线的差异.结果 MARS治疗后,平均心率减慢,平均动脉压升高,PaO2及氧合指数水平均显著升高,气道峰压降低,尿量增加,TBil降低,PLT显著增加,D-二聚体显著降低,促炎性介质(NO、IL-6、IL-8、TNF-α、LBP)与抗炎性介质(IL-10、IL-13)水平显著降低,Marshall值降低,明显优于常规综合治疗对照组和CRRT组(P＜0.05).MARS治疗后,呼吸频率降低、SaO2明显升高,Cr水平降低,明显优于常规综合治疗对照组(P＜0.05).MARS组治疗后60 d的生存率为80%(20/25),优于常规综合治疗组(9/25,36%)(P＜0.01)和CRRT组(13/25,52%)(P＜0.05).结论 MARS治疗重症肺炎合并MODS患者的疗效优于常规综合治疗和CRRT治疗.

abstractsObjective To evaluate the effect of molecular adsorbent recirculating system(MARS)in treatment of severe pneumonia complicated with multiple organ dysfunction syndrome(MODS).Methods Seventy-five patients who were diagnosed as severe pneumonia complicated with MODS were randomly divided into MARS group,continuous renal replacement therapy(CRRT)group and routine comprehensive therapy group.Flow dynamics,respiration function,liver function and renal function,coagulation function,inflammatory mediators,and Marshall scores were measured and compared before and after the treatment. The survival curves in 60 days were also compared among three groups.Results With MARS therapy,mean heart rates,peak inspiratory airway pressure,serum TBil,plasma D-dimmer levels and Marshall score were decreased;mean artery pressure,PaO2,oxygenation index,urine output,and platelet counts were increased;the levels of proinflammatory(NO,IL-6,IL-8,TNF-α and LBP)and anti-inflammatory(IL-10 and IL-13)mediator were decreased remarkably.The differences of these indicators between MARS group and other two groups were statistically significant(P＜0.05).And after MARS therapy,respiratory rate and Cr level were decreased,while SaO2 and WBC were increased significantly(P＜0.05).The 60 day-survival rate in MARS group was 80%(20/25),36%(9/25)in routine comprehensive therapy,and 52%(13/ 25)in CRRT group(P＜0.05).Conclusion MARS therapy has better effect on severe pneumonia conplicated with MODS than routine comprehensive therapy and CRRT.