间歇性高容量血液滤过对严重脓毒症急性肾损伤患者血液炎性因子及肾功能的影响

The effects of intermittent high-volume blood filtration on blood inflammatory factors and renal function in patients with severe sepsis-induced acute kidney injury

目的:探讨间歇性高容量血液滤过对严重脓毒症急性肾损伤患者血清炎性因子及肾功能的影响。方法:选择2016年9月至2017年4月收治的60例严重脓毒症急性肾损伤患者为研究对象,根据治疗方案不同分为观察组与对照组,每组30例,对照组患者接受连续性血液滤过(CVVH)治疗,观察组患者接受间歇性高容量血液滤过(PHVHF)治疗,采用ELISA法检测两组患者治疗前后血清白介素-6(IL-6)、白介素-10(IL-10)、C-反应蛋白(CRP)以及肿瘤坏死因子-α(TNF-α)水平;记录两组患者治疗前后血清肌酐(SCr)、24 h尿量以及肾功能开始恢复时间。结果:治疗后,两组患者血清IL-6、IL-10、CRP以及TNF-α水平均有改善(P<0.05),且观察组患者上述指标均低于对照组(P<0.05);治疗后,两组患者24 h尿量、血清SCr水平均有改善(P<0.05),两组患者治疗后24 h尿量、血清SCr及肾功能开始恢复时间比较,差异均无统计学意义(P>0.05)。结论:PHVHF治疗可获得与CVVH相同的肾功能保护作用,对血清炎性细胞因子的清除效果更好,是严重脓毒症肾损伤的重要辅助治疗手段。

Objective： To investigate the effect of intermittent high-volume blood filtration on blood inflammatory factors and renal function in patients with severe sepsis-induced acute kidney injury. Methods： 60 patients with severe sepsis-induced acute kidney injury treated from September 2016 to April 2017 were selected as the research objects and divided into the observation group and the control group according to the different treatment plans, with 30 cases in each group. The patients in the control group were treated with continuous hemofiltration （CVVH） therapy while the patients in the observation group were given intermittent high volume hemofiltration （PHVHF） treatment. The serum interleukin-6 （IL-6）, interleukin-10 （IL-10）, c-reactive protein （CRP） and tumor necrosis factor-α （TNF-α） before and after treatment were detected by ELISA in the two groups. Serum creatinine （SCr）, 24h urine volume and the initial recovery time of renal function before and after treatment were recorded in the two groups. Results： After the treatment, the levels of IL-6, IL-10, CRP, and TNF-α were improved in the two groups and all the indexes in the observation group were significantly lower than those of the control group （ P 〉0.05）. After the treatment, the levels of 24h urine volume and SCr were improved in the two groups, while there were no significant differences in the levels of 24h urine volume, SCr and the initial recovery time of renal function in the two groups （ P 〉0.05）. Conclusion： PHVHF can achieve the same renal function improvement as CVVH, and has stronger scavenging effect of inflammatory factors, which is an important adjuvant therapy for severe sepsis-induced acute kidney injury.