连续性肾脏替代治疗对严重脓毒症患者肾功能及微循环的影响

Effects of continuous renal replacement therapy on renal function and microcirculation in patients with severe sepsis

目的:探讨连续性肾脏替代治疗(CRRT)对严重脓毒症患者肾功能及微循环的影响。方法:选取2014年3月至2015年3月南京医科大学附属淮安第一医院重症医学科收治的120例严重脓毒症患者,按随机数字表法分为研究组和对照组,每组60例。对照组采用常规方法治疗,研究组在对照组治疗的基础上加用CRRT。观察两组治疗前、后微循环变化及预后情况,并比较两组患者血浆内皮素(ET)、嗜铬粒蛋白A(CHGA)及血清尿素氮(BUN)、肌酐(SCr)、C反应蛋白(CRP)、白蛋白(ALB)水平。结果:治疗前,两组患者总血管密度(TVD)、灌注血管密度(PVD)、灌注血管比例(PPV)及微血管流动指数(MFI)比较差异均无统计学意义(均P>0.05);治疗1d及3d后,研究组TVD低于对照组,PVD、PPV及MFI均高于对照组,两组比较差异均有统计学意义(均P<0.05)。治疗后,研究组血浆CHGA、ET及血清CRP、SCr、BUN水平、CRP/ALB比值均较对照组明显降低(均P<0.05),ALB水平显著升高(P<0.05)。与对照组比较,研究组治疗后急性生理和慢性健康(APACHEⅡ)评分及28d病死率显著降低(P<0.05)。结论:CRRT可通过抑制机体炎症反应,有效改善严重脓毒症患者的肾功能及微循环状态,并能显著改善患者预后。

Objective： To investigate the effects of continuous renal replacement therapy （CRRT） on renal function and microcirculation in patients with severe sepsis. Methods： 120 cases of patients with severe sepsis treated in our hospital from March 2014 to March 2015 were divided into a control group and an observation group according randomly, 60 cases in each group. Patients in the control group were treated by conventional method. In the observation group was treated with CRRT on the basis of conventional method. The microcirculation, plasma endothelin （ET）, chromogranin A （CHGA）, blood urea nitrogen （BUN）, serum ereatinine （SCr）, C reactive protein （CRP） and albumin （ALB） levels before and after treatment and 28 day mortality between the two groups were compared. Results： There was no significant difference in total vascular density （TVD）, perfusion vascular density （PVD）, perfusion vessel ratio （PPV） and microvascular flow index （MFI） between the two groups before treatment （all P〈0.05）. The TVD of the observation group was significant lower while PVD, PPV and MFI were significantly higher than those of the control group on day 1 and 3 after treatment （P〈0.05）. The plasma CHGA, ET, serum CRP, SCr and BUN levels were significantly lower while ALB level was higher in the observation group than those in the control group （P〈0.05）. After the treatment for 3 days, acute physiology and chronic health evaluation （APACHE Ⅱ ） score was significantly decreased （P〈0.05）. The 28 d mortality rate of observation group was significantly lower than that of the control group （P〈0.05）. Conclusion： CRRT could significantly improve renal function, microcirculation and the prognosis of patients with severe sepsis.