连续性肾脏替代疗法治疗脓毒症的疗效及其对微循环状态的影响

Efficacy of continuous renal replacement therapy for sepsis and its effect on microcirculation

目的探讨连续性肾脏替代疗法(CRRT)治疗脓毒症的疗效及其对微循环状态的影响。方法回顾性分析106例脓毒症患者临床资料,其中行CRRT治疗53例,非CRRT治疗53例。比较两组治疗前后急性生理功能和慢性健康状况评分(APACHE)Ⅱ及炎症、血流动力学、微循环状态相关指标的差异。结果治疗后,两组患者WBC计数、体温、心率、血小板压积、超敏C反应蛋白、肿瘤坏死因子-α水平及APACHEⅡ评分均较治疗前降低,且CRRT组患者除体温外各指标的改善程度均优于非CRRT组(均P<0.05);治疗前后两组患者中心静脉压、平均动脉压和氧合指数的比较差异均无统计学意义(P>0.05);治疗后,两组患者血液流态积分、襻周状态积分、管襻形态积分、总积分均降低,襻顶血管直径增大,且CRRT组以上各指标的改善程度均优于非CRRT组(均P<0.05)。结论 CRRT可以显著改善脓毒症患者的感染状况,促进微循环状态的恢复。

Objective To investigate the efficacy of continuous renal replacement therapy （CRRT） for the treatment of sepsis and its effect on microcirculation .Methods Clinical data of 106 patients with sepsis were analyzed retrospectively , including 53 with CRRT （CRRT group） and another 53 without CRRT（non-CRRT group）.The Acute Physiology and Chronic Health Evaluation （APACHE）Ⅱ scores and the relevant parameters of inflammation ,haemodynamics and microcirculation were compared between the two groups .Results After treatment,WBC count,temperature,heart rate,thrombocytocrit,levels of high-sensitivity C-reactive protein and tumor necrosis factor-α, and APACHE Ⅱ scores were all lower than those before treatment , moreover, all of the indicators except for temperature had better improvements in the CRRT group compared to the non-CRRT group（all P〈0.05）.There were no significant differences in the central venous pressure,mean arterial pressure or oxygenation index between the two groups before and after treatment （P〉0.05）.After treatment, the blood flow score ,peripheral loop state score ,capillary loop morphology score and total score decreased ,while the top loop vessel diameter increased in the two groups （ all P〈0.05） ,and the improvements of all indicators mentioned above in the CRRT group were superior to those in the non-CRRT group（all P〈0.05）.Conclusion CRRT could significantly improve the infection status of patients with sepsis and promote the recovery of microcirculation .