CRRT对SIRS合并CLS患者血流动力学指标APACHEⅡ评分及住院时间的影响研究

Influence on the haemodynamics index, APACHE Ⅱ , hospital stays for the patients with SIRS combine with CLS by CRRT

目的探讨连续性。肾脏替代治疗（continuous renal replacement therapy，CRRT）对全身炎症反应综合征（systemic inflammatory response syndrome，SIRS）合并毛细血管渗漏综合征（eapilllary leak syndrome，CLS）患者血流动力学指标、APACHEⅡ评分及住院时间的影响。方法选取2013—02～2015-02我院收治的82例SIRS合并CLS患者，40例行CRRT的患者为试验组，42例因家庭经济原因未接受CRRT方案的患者为对照组，对照组患者给予常规综合治疗，试验组患者在此基础上实施CRRT治疗，比较两组患者治疗前及治疗后48h中心静脉压（central venous pressure，CVP）、平均动脉压（mean artefial pressure，MAP）、氧合指数（oxygenation index，OI）、心率（heaar ate，HR）、尿量、血管外肺水（extravascular lung water，EVLW）、肺血管通透性指数（pulmonary vaseular permeability index，PVPI）、白细胞计数（white blood cell count，WBC）、C反应蛋白（c—reactive protein，CRP）水平变化情况以及治疗后两组患者APACHEⅡ评分及住院时间。结果试验组患者治疗后MAP、OI及尿量均明显高于对照组[（92．16±11．01）mmHg vs．（84．15±11．68）mmHg、（231．06±33．68）mmHgvs．（189．48±31．97）mmHg、（73．11±12．67）mL／hvs．（52．17±11．06）mL／h1，差异有统计学意义（P〈0．05）；试验组患者治疗后EVLW、PVPI均明显低于对照组[（7．09±0．58）mL／kgvs．（8．72±0．52）mL／kg、（2．27±0．82）％vs．（3．85±0．80）％1，差异有统计学意义（P〈0．05）；试验组患者治疗后WBC、CRP均明显低于对照组[（10．59±3．15）×10^9/Lvs．（14．81±3．56）×10^9/L、（70．15±30．08）mg／Lvs．（100．26±45．51）mg／L]，差异有统计学意义（P〈0．05）；试验组患者治疗后APACHEII评分和住院时间均明显低于对照组[（10．01±3．97）分vs．13．12±5．11）分、（85．97±20．08）hvs．（135．16±25．17）h1，差异有统计学意义（P〈0．05）。结论CRRT可有效改善SIRS合并CLS患者血流动力学指标和炎症指标，改善微循环，促进排尿，降低毛细血管通透性，能够提高预后效果。

Objective To explore the influence on the haemodynamics index, APACHE Ⅱ , hospital stays for the patients with systemic inflammatory response syndrome combine with capillary leak syndrome by continuous renal replacement therapy （CRRT）. Methods Eighty-two cases of patients with systemic inflammatory response syndrome combine with capillary leak syndrome were investigated; 40 cases of patients were treated by CRRT as the experiment group, and 42 cases of patients were not treated by CRRT as the control group. The patients in control group were treated by routine comprehen sive treatment; on the basis of the control group, the patients in experiment group were treated by CRRT. The central venous pressure, mean arterial pressure, oxygenation index, heart rate, urine volumc, intra-abdominal pressure, extravascular lung water, pulmonary vascular permeability index, white blood cell count, c-reactive protein, APACHE H , hospital stays were compared. Results The MAP, OI, urine volume in the experiment group were higher than those in the control group（92.16±11.01 vs, 84.15± 11.68） mm Hg, （231.06±33.68 vs. 189.48±31.97） mm Hg, （73.11±12.67 vs. 52.17±11.06） mL/h（P〈 0.05）. The levels of EVLW, PVPI in the experiment group were lower than those in the control group （7.09±0.58 vs. 8.72±0.52） mL/kg, （2.27±0.82 vs. 3.85±0.80）%（P 〈 0.05）. The levels of WBC, CRP in the experiment group were lower than those in the control group （10.59±3.15 vs. 14.81 ±3.56）× 10^9/L, （70.15±30.08 vs. 100.26±45.51 ） mg/L （P 〈 0.05）. The scores of APACHE Ⅱ , hospital stays for the experiment group were lower than the control group （ 10.01 ±3.97 vs. 13.12 ±5.11 ） , （ 85.97 ±20.08 vs. 135.16±25.17） h（P〈0.05）. Conclusion CRRT can improve the hemodynamic index, inflammatory markers, microcirculation for the patients with systemic inflammatory response syndrome combine with capillary leak syndrome; it can also promote urination, reduce the capillary permeability, and improve the prognosis.