连续性肾脏替代治疗改善脓毒症患者早期肝功能障碍的临床探讨

The effect of continuous renal replacement therapy on patients with early hepatic dysfunction induced by sepsis

目的探讨连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)对脓毒症早期肝功能障碍患者的治疗效果。方法收集阳江市第一人民医院2013年1月~2016年12月入住ICU的严重肺部感染合并脓毒症肝功能障碍患者287例,所有患者随机分为CRRT治疗组与对照组(常规药物治疗组),其中CRRT治疗组156例,对照组131例。所有患者在检测出肝功能异常后的第1d、3d、7d清晨分别抽血检测丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、总胆红素(serum total bilirubin,STB)、白蛋白(albumin,Alb)、凝血酶原时间(prothrombin time,PT)等肝功能指标用于统计分析。结果 2组患者治疗3天后,与对照组比较AST(F=8.705,P=0.014)、STB(F=9.016,P=0.009)差异具有统计学意义,白蛋白、PT、ALT差异无统计学意义(P>0.05)。经过7天治疗后,与对照组比较ALT(F=8.413,P=0.016)、AST(F=7.812,P=0.023)、STB(F=9.413,P=0.005)差异具有统计学意义;白蛋白、PT差异无统计学意义(P>0.05)。结论 CRRT能显著改善脓毒症早期肝功能障碍患者的肝功能状态。

Objective To investigate the clinical effects of continuous renal replacement therapy（CRRT） for the treatment of patients with early hepatic dysfunction induced by sepsis. Methods A total of 287 cases with liver dysfunction after severe pulmonary infection and sepsis and treated in the ICU of First People＇s Hospital of Yangjiang city from Jan. 2013 to Dec. 2016 were recruited. The patients were randomly divided into CRRT group（n=156） and control group（routine treatment group, n=131）. Blood samples were collected at the 1 st, 3 rd and 7 th day in the early morning after the presence of hepatic dysfunction for the measurement of alanine aminotransfease（ALT）, aspartate aminotransferase（AST）, serum total bilirubin（STB）, albumin（ALB） and prothrombin time（PT）. Laboratory parameters were used for statistical analyses. Results After the treatment for 3 days, changes of AST（F=8.705, P=0.014） and STB（F=9.016, P=0.009） were statistically significant（P〈0.05） in CRRT group as compared with those in control group, but ALB, ALT and PT had no statistical differences（P〈0.05）. After the treatment for 7 days, changes of ALT（F=8.413, P=0.016）,AST（F=7.812, P=0.023） and STB（F=9.413, P=0.005） were statistically significant（P〈0.05） as compared with those in control group, but ALB and PT had no statistical differences（P〈0.05）. Conclusion CRRT can improve the patients with early liver dysfunction induced by sepsis.