早期连续性血液净化对老年重症脓毒症合并急性肾损伤患者血清炎症指标的影响

Effect of early continuous blood purification on serum inflammatory indexes in elderly patients with severe sepsis complicated with acute renal injury

目的探讨早期连续性血液净化对老年重症脓毒症合并急性肾损伤患者血清炎症指标的影响。方法选取2018年3月2020年3月本院住院治疗的106例老年重症脓毒症并AKI患者,随机分成2组,对照组行常规治疗,研究组在常规治疗基础上行早期连续性血液净化,观察两组APACHEⅡ评分、肾功能指标(Scr、CysC)、炎症指标(TNF-α、CRP)变化,并记录两组存活率、ICU住院时间。结果治疗后7d、15d两组患者APACHEⅡ评分均较治疗前明显降低(P<0.05),而研究组治疗后7d、15d APACHEⅡ评分均明显低于同期对照组(P<0.05);研究组治疗后15d、30d存活率均高于对照组(P<0.05),且ICU住院时间较对照组明显缩短(P<0.05);治疗后1d、3d两组患者血清TNF-α、CRP、Scr、CysC均呈显著降低,且与治疗前比较存在显著性差异(P<0.05),组间比较发现,研究组治疗后1d、3d血清TNF-α、CRP水平均明显低于对照组,差异有统计学意义(P<0.05)。结论早期连续性血液净化治疗老年重症脓毒症AKI患者能迅速清除机体炎症介质,减轻肾损伤,遏制病情发展,值得临床推广。

Objective To explore the effect of early continuous blood purification on serum Scr,CysC,and TNF-a factors in elderly patients with severe sepsis and acute kidney injury(AKI).Methods March 2018 to March2020106 elderly patients with severe sepsis and AKI who were hospitalized in our hospital were randomly divided into 2 groups.The control group received routine treatment.The research group received early continuous blood purification on the basis of conventional treatment.The APACHE II score and renal function indexes of the two groups were observed.(Scr,CysC),inflammatory mediators(TNF-α,CRP)changes,and record the survival rate and ICU hospital stay of the two groups.Results The APACHEⅡscores of the two groups were significantly lower at 7 days and 15 days after treatment than before treatment(P<0.05),and the APACHEⅡscores of the study group were significantly lower than those of the control group at 7 d and 15 d after treatment(P<0.05);the survival rates of the study group at 15 d and 30 d were higher than those of the control group(P<0.05),and the ICU stay was The control group was significantly shortened(P<0.05);the serum TNF-α,CRP,Scr,CysC of the two groups were significantly reduced 1 d and3 d after treatment,and there was a significant difference compared with before treatment(P<0.05),between groups Comparative discovery,research The levels of serum TNF-αand CRP were significantly lower than those of the control group 1 d and 3 d after treatment,and the difference was statistically significant(P<0.05).Conclusions Early continuous blood purification treatment of elderly patients with severe sepsis AKI can quickly clear the body Inflammatory mediators,reduce kidney damage,and curb the development of the disease,it is worthy of clinical promotion.